Healthcare Provider Details

I. General information

NPI: 1003724154
Provider Name (Legal Business Name): ROOTED COMMUNITY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13050 S 55TH ST # A
PAPILLION NE
68133-2941
US

IV. Provider business mailing address

13050 S 55TH ST # A
PAPILLION NE
68133-2941
US

V. Phone/Fax

Practice location:
  • Phone: 515-515-2426
  • Fax:
Mailing address:
  • Phone: 515-515-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KAYLA BUBNYS
Title or Position: PROGRAM MANAGER/ SUPERVISOR
Credential: NCSP
Phone: 515-515-2426