Healthcare Provider Details

I. General information

NPI: 1497399125
Provider Name (Legal Business Name): ROOTS TO RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 NW 7TH COURT
BOYNTON BEACH FL
33426
US

IV. Provider business mailing address

101 S. FEDERAL HIGHWAY APT# 513
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 561-777-0045
  • Fax:
Mailing address:
  • Phone: 561-777-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KATRINA LYNN CHASE
Title or Position: OWNER & CEO
Credential:
Phone: 561-777-0045