Healthcare Provider Details

I. General information

NPI: 1568382455
Provider Name (Legal Business Name): ROOTED TO RISE COLLECTIVE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 LEYTON RD
BEDFORD OH
44146-2125
US

IV. Provider business mailing address

31 LEYTON RD
BEDFORD OH
44146-2125
US

V. Phone/Fax

Practice location:
  • Phone: 216-256-9072
  • Fax:
Mailing address:
  • Phone: 216-256-9072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMINI DAIS
Title or Position: MARRIAGE & FAMILY THERAPIST
Credential: IMFT
Phone: 216-256-9072