Healthcare Provider Details

I. General information

NPI: 1356238802
Provider Name (Legal Business Name): ROOTED HEART SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N 31ST ST
CAMDEN NJ
08105-1418
US

IV. Provider business mailing address

PO BOX 28
SICKLERVILLE NJ
08081-0028
US

V. Phone/Fax

Practice location:
  • Phone: 856-308-5088
  • Fax:
Mailing address:
  • Phone: 856-246-2926
  • 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
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LETISHA A AYTCH
Title or Position: CEO
Credential: B.S.HEALTHCARE ADMIN
Phone: 856-246-2926