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General NPI Number Information
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NPI Number | 1568284040
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Entity Type | Organization
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Legal Business Name | ROOTED HEALTHCARE LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 100 S 4TH ST STE 550
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City | SAINT LOUIS
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State | MO
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Zip | 63102-1897
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Country | US
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Telephone | 636-779-9296
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Fax |
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Provider Business Mailing Address
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Address Line | 16513 WILLOW GLEN DR
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City | GROVER
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State | MO
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Zip | 63040-1748
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Country | US
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Telephone | 636-779-9296
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TWALLA HANNA
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Credential |
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Telephone | 636-779-9298
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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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