Healthcare Provider Details

I. General information

NPI: 1851287981
Provider Name (Legal Business Name): ROOTED CARE ROXBURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 BOLYSTON 5TH FLOOR #1382
BOSTON MA
02116
US

IV. Provider business mailing address

867 BOLYSTON 5TH FLOOR #1382
BOSTON MA
02116
US

V. Phone/Fax

Practice location:
  • Phone: 617-917-2022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FOOS OMAR
Title or Position: OWNER
Credential: DNP
Phone: 617-917-2022