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General NPI Number Information
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NPI Number | 1073437323
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Entity Type | Organization
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Legal Business Name | RENEWED ROOTS NW LLC
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Dates
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Enumeration Date | 08/08/2026
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Last Update Date | 08/08/2026
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Provider Practice Location Address
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Address Line | 12905 N CHERRY ST
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City | MEAD
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State | WA
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Zip | 99021-9610
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Country | US
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Telephone | 509-866-8417
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Fax |
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Provider Business Mailing Address
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Address Line | 12905 N CHERRY ST
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City | MEAD
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State | WA
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Zip | 99021-9610
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Country | US
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Telephone | 509-866-8417
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR OF OPERATIONS
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Name | TARRI ANNE WARD
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Credential |
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Telephone | 509-866-8417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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