Healthcare Provider Details

I. General information

NPI: 1265374979
Provider Name (Legal Business Name): PURE ROOTS CARE COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14589 S ROBERT TRL UNIT 405
ROSEMOUNT MN
55068-3206
US

IV. Provider business mailing address

14589 S ROBERT TRL UNIT 405
ROSEMOUNT MN
55068-3206
US

V. Phone/Fax

Practice location:
  • Phone: 608-799-8371
  • Fax:
Mailing address:
  • Phone: 608-799-8371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLARISSA THOMSON
Title or Position: OWNER
Credential: RN
Phone: 608-799-8371