Healthcare Provider Details

I. General information

NPI: 1639034838
Provider Name (Legal Business Name): ROOTED GLORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 RISING SUN RD
PALMYRA VA
22963-4508
US

IV. Provider business mailing address

388 RISING SUN RD
PALMYRA VA
22963-4508
US

V. Phone/Fax

Practice location:
  • Phone: 434-882-5007
  • Fax:
Mailing address:
  • Phone: 434-882-5007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: QUIYANA WHITE
Title or Position: CEO/FOUNDER
Credential: CNA
Phone: 434-882-5007