Healthcare Provider Details

I. General information

NPI: 1689587198
Provider Name (Legal Business Name): ROOTS & WINGS FAMILY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 S JONES BLVD STE 106
LAS VEGAS NV
89146-5605
US

IV. Provider business mailing address

11586 MONTE ISOLA ST
LAS VEGAS NV
89141-3296
US

V. Phone/Fax

Practice location:
  • Phone: 775-462-2140
  • Fax:
Mailing address:
  • Phone: 775-462-2140
  • Fax: 702-931-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RATHENA DOBBS
Title or Position: PRESIDENT
Credential:
Phone: 775-462-2140