Healthcare Provider Details

I. General information

NPI: 1730001165
Provider Name (Legal Business Name): RADIANT ROOTS ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1568 W SYLVANIA AVE UNIT 6445
TOLEDO OH
43612-7505
US

IV. Provider business mailing address

1568 W SYLVANIA AVE UNIT 6445
TOLEDO OH
43612-7505
US

V. Phone/Fax

Practice location:
  • Phone: 567-317-1177
  • Fax:
Mailing address:
  • Phone: 567-317-1177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA NELSON
Title or Position: FOUNDER & EXECUTIVE DIRECTOR
Credential:
Phone: 567-317-1177