Healthcare Provider Details

I. General information

NPI: 1114854072
Provider Name (Legal Business Name): ROOTED LIFE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 N HIMES AVE APT 1010
TAMPA FL
33614-8306
US

IV. Provider business mailing address

PO BOX 27005
TAMPA FL
33623-7005
US

V. Phone/Fax

Practice location:
  • Phone: 813-519-2851
  • Fax:
Mailing address:
  • Phone: 813-519-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: NIJAH SIEARRA SLAUGHTER
Title or Position: CEO
Credential:
Phone: 813-519-2851