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General NPI Number Information
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NPI Number | 1265374979
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Entity Type | Organization
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Legal Business Name | PURE ROOTS CARE COLLECTIVE
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 14589 S ROBERT TRL UNIT 405
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City | ROSEMOUNT
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State | MN
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Zip | 55068-3206
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Country | US
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Telephone | 608-799-8371
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Fax |
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Provider Business Mailing Address
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Address Line | 14589 S ROBERT TRL UNIT 405
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City | ROSEMOUNT
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State | MN
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Zip | 55068-3206
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Country | US
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Telephone | 608-799-8371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLARISSA THOMSON
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Credential | RN
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Telephone | 608-799-8371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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