Healthcare Provider Details

I. General information

NPI: 1053167544
Provider Name (Legal Business Name): ROOTED GROWTH BEHAVIORAL HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39899 BALENTINE DR STE 200
NEWARK CA
94560-5361
US

IV. Provider business mailing address

16328 BLANCO ST
ASHLAND CA
94578-3126
US

V. Phone/Fax

Practice location:
  • Phone: 510-820-4080
  • Fax: 341-946-6174
Mailing address:
  • Phone: 510-820-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LETICIA ROSAS VERA
Title or Position: FOUNDER/PRESIDENT
Credential: BCBA
Phone: 510-820-4080