Healthcare Provider Details

I. General information

NPI: 1902696735
Provider Name (Legal Business Name): ROOTS OF REENTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 S MARIPOSA WAY
DENVER CO
80223-2746
US

IV. Provider business mailing address

718 S MARIPOSA WAY
DENVER CO
80223-2746
US

V. Phone/Fax

Practice location:
  • Phone: 720-561-9452
  • Fax:
Mailing address:
  • Phone: 720-561-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LOVVIE SANDOVAL
Title or Position: FOUNDER
Credential:
Phone: 720-561-9452