Healthcare Provider Details

I. General information

NPI: 1295645182
Provider Name (Legal Business Name): ROOTED FAMILY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 N GREENVIEW AVE
CHICAGO IL
60642-7019
US

IV. Provider business mailing address

1426 N GREENVIEW AVE
CHICAGO IL
60642-7019
US

V. Phone/Fax

Practice location:
  • Phone: 312-656-7137
  • Fax:
Mailing address:
  • Phone: 312-656-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: KALEA WILLIAMS
Title or Position: OWNER
Credential: NP
Phone: 312-656-7137