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General NPI Number Information
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NPI Number | 1578402962
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Entity Type | Organization
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Legal Business Name | URBAN R.O.O.T.S. ALLIANCE, NFP
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Dates
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Enumeration Date | 03/28/2026
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Last Update Date | 03/28/2026
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Provider Practice Location Address
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Address Line | 1 E ERIE ST
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 773-718-2518
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Fax |
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Provider Business Mailing Address
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Address Line | 1 E ERIE ST
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 773-718-2518
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ISHALENA MOORE
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Credential |
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Telephone | 323-453-6989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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