MEDICARE: ALTARED ROOTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1851973770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTARED ROOTS LLC

Provider Business Mailing Address
First Line	:	11002 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-2126
Country	:	US
Telephone Number	:	301-467-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	11002 12TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-2126
Country	:	US
Telephone Number	:	301-467-5612
Fax Number	:

Authorized Official
Title or Position	:	DOULA
Name	:	GERARD DOUGLAS MILLER JR.
Credential	:	C-FSD, C-CBE, I-CBE,
Telephone Number	:	301-467-5612

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	01/23/2026

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