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General NPI Number Information
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NPI Number | 1083419808
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Entity Type | Organization
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Legal Business Name | ROOTS CARE LIVING LLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 9719 BROOKS BEND RD
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City | LOUISVILLE
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State | KY
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Zip | 40258-4625
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Country | US
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Telephone | 903-617-4334
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Fax |
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Provider Business Mailing Address
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Address Line | 9719 BROOKS BEND RD
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City | LOUISVILLE
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State | KY
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Zip | 40258-4625
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Country | US
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Telephone | 903-617-4334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NYIMA DARBOE
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Credential | RN
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Telephone | 903-617-4334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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