Healthcare Provider Details

I. General information

NPI: 1578320131
Provider Name (Legal Business Name): WELL ROOTED HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WILSON ST
BIDDEFORD ME
04005-3811
US

IV. Provider business mailing address

17 WILSON ST
BIDDEFORD ME
04005-3811
US

V. Phone/Fax

Practice location:
  • Phone: 302-722-7002
  • Fax:
Mailing address:
  • Phone: 302-722-7002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA LOUISE KUHS
Title or Position: DIRECTOR
Credential:
Phone: 302-722-7002