Healthcare Provider Details

I. General information

NPI: 1376499376
Provider Name (Legal Business Name): ROOTS OF HOPE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GUILFORD DR STE 200
FREDERICK MD
21704-5264
US

IV. Provider business mailing address

7100 GUILFORD DR STE 200
FREDERICK MD
21704-5264
US

V. Phone/Fax

Practice location:
  • Phone: 512-788-8867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLY AMIKE NGENGE
Title or Position: OWNER
Credential:
Phone: 512-788-8867