Healthcare Provider Details

I. General information

NPI: 1841874237
Provider Name (Legal Business Name): ROOTED IN RECOVERY THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N BATTERY ST
HIGHLAND SPRINGS VA
23075-1107
US

IV. Provider business mailing address

PO BOX 50451
RICHMOND VA
23250-0451
US

V. Phone/Fax

Practice location:
  • Phone: 804-833-0467
  • Fax: 804-616-4845
Mailing address:
  • Phone: 804-833-0467
  • 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: AL BERRY
Title or Position: MANAGER
Credential:
Phone: 469-915-4211