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General NPI Number Information
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NPI Number | 1538038203
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Entity Type | Organization
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Legal Business Name | LIFE ROOTED FOUNDATION
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Dates
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Enumeration Date | 11/01/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 9436 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90047-3856
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Country | US
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Telephone | 310-591-8198
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Fax |
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Provider Business Mailing Address
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Address Line | 619 S FREMONT AVE STE C
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City | ALHAMBRA
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State | CA
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Zip | 91803-1337
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Country | US
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Telephone | 310-591-8198
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Fax | 866-504-4012
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MARCUS HONG
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Credential |
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Telephone | 323-646-2772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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