=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639034838
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOTED GLORY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2025
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 388 RISING SUN RD
-----------------------------------------------------
City | PALMYRA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22963-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-882-5007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 388 RISING SUN RD
-----------------------------------------------------
City | PALMYRA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22963-4508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-882-5007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/FOUNDER
-----------------------------------------------------
Name | QUIYANA WHITE
-----------------------------------------------------
Credential | CNA
-----------------------------------------------------
Telephone | 434-882-5007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347C00000X
-----------------------------------------------------
Taxonomy Name | Private Vehicle
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------