Healthcare Provider Details

I. General information

NPI: 1912763558
Provider Name (Legal Business Name): ROOTS CHILDRENS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 MONROE ST STE 400
DEARBORN MI
48124-2842
US

IV. Provider business mailing address

1537 MONROE ST STE 400
DEARBORN MI
48124-2842
US

V. Phone/Fax

Practice location:
  • Phone: 313-704-9044
  • Fax:
Mailing address:
  • Phone: 313-451-0415
  • Fax: 313-514-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ENASS ASKAR
Title or Position: PRESIDENT
Credential: MS, BCBA
Phone: 313-451-0415