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General NPI Number Information
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NPI Number | 1518803535
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Entity Type | Organization
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Legal Business Name | ROOTS, LLC
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 5105 S HARPER AVE UNIT 414
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City | CHICAGO
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State | IL
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Zip | 60615-4156
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Country | US
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Telephone | 708-673-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 308 S JEFFERSON ST STE 190
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City | CHICAGO
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State | IL
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Zip | 60661-5605
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Country | US
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Telephone | 708-673-6600
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Fax |
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Authorized Official
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Title or Position | REGIONAL ADMINISTRATOR
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Name | ASANTE K YUGEN
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Credential | MANAGER
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Telephone | 708-673-6600
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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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