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General NPI Number Information
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NPI Number | 1285347005
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Entity Type | Organization
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Legal Business Name | ROOTED 303
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Dates
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Enumeration Date | 12/27/2022
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 5933 S FAIRFIED STREET
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City | LITTLETON
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State | CO
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Zip | 80120
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Country | US
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Telephone | 303-729-3681
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Fax |
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Provider Business Mailing Address
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Address Line | 5933 S FAIRFIELD ST
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City | LITTLETON
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State | CO
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Zip | 80120-2821
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Country | US
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Telephone | 303-729-3681
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. DOMINGO CRUZ
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Credential |
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Telephone | 303-729-3681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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