Healthcare Provider Details

I. General information

NPI: 1720901341
Provider Name (Legal Business Name): 4ROOTS FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 W PRINCETON ST
ORLANDO FL
32804-4706
US

IV. Provider business mailing address

1918 W PRINCETON ST
ORLANDO FL
32804-4706
US

V. Phone/Fax

Practice location:
  • Phone: 407-775-6424
  • Fax:
Mailing address:
  • Phone: 407-775-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY GROVES
Title or Position: EXECUTIVE DIRECTOR
Credential: EDD
Phone: 615-260-0347