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General NPI Number Information
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NPI Number | 1255105482
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Entity Type | Organization
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Legal Business Name | APPLEROOTS SERVICES
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 21 FOREST PARK APT 4
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City | PORTLAND
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State | ME
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Zip | 04101-1725
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Country | US
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Telephone | 651-279-7215
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Fax |
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Provider Business Mailing Address
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Address Line | 2740 MINNEHAHA AVE APT 402
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City | MINNEAPOLIS
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State | MN
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Zip | 55406-2897
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Country | US
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Telephone | 651-279-7215
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Fax |
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Authorized Official
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Title or Position | CO- OWNER
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Name | MS. SUMAYA SALAAD SHARDI
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Credential |
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Telephone | 651-279-7215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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