Healthcare Provider Details

I. General information

NPI: 1184533127
Provider Name (Legal Business Name): MOTHER ROOTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3942 SE HAWTHORNE BLVD
PORTLAND OR
97214-5242
US

IV. Provider business mailing address

3942 SE HAWTHORNE BLVD
PORTLAND OR
97214-5242
US

V. Phone/Fax

Practice location:
  • Phone: 510-993-9063
  • Fax:
Mailing address:
  • Phone: 510-993-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: SARAH HUSAIN
Title or Position: REGISTERED AGENT
Credential: LDEM
Phone: 510-993-9063