Healthcare Provider Details

I. General information

NPI: 1124735014
Provider Name (Legal Business Name): ROOTED COMMUNITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 FAYETTE ST
CLINTON IA
52732-7111
US

IV. Provider business mailing address

446 16TH AVE
EAST MOLINE IL
61244-2013
US

V. Phone/Fax

Practice location:
  • Phone: 563-241-2969
  • Fax:
Mailing address:
  • Phone: 563-241-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMBER BORDOLO
Title or Position: OWNER
Credential:
Phone: 563-241-2969