Healthcare Provider Details

I. General information

NPI: 1992161152
Provider Name (Legal Business Name): THE ROOST TRAINING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 CENTAUR VILLAGE DR
LAFAYETTE CO
80026-2814
US

IV. Provider business mailing address

1304 CENTAUR VILLAGE DR
LAFAYETTE CO
80026-2814
US

V. Phone/Fax

Practice location:
  • Phone: 720-420-0848
  • Fax:
Mailing address:
  • Phone: 720-420-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KENDRA MCMANUS
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential:
Phone: 720-420-0848