=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528884129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A ROOTED LIFE COMPANY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2024
-----------------------------------------------------
Last Update Date | 06/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2951 ELKTON TRL STE B
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75703-0675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-865-0073
-----------------------------------------------------
Fax | 888-453-0568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75762-0005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-865-0073
-----------------------------------------------------
Fax | 888-453-0568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMANDA K BLUNDELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-865-0073
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------