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General NPI Number Information
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NPI Number | 1740990928
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Entity Type | Organization
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Legal Business Name | ROOTS OF ADDICTION COUNSELING CENTER LLC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 1101 SYLVAN AVE STE C103
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City | MODESTO
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State | CA
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Zip | 95350-1687
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Country | US
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Telephone | 209-578-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 SYLVAN AVE STE C103
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City | MODESTO
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State | CA
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Zip | 95350-1687
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Country | US
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Telephone | 209-578-7477
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID RAESE
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Credential |
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Telephone | 209-758-7477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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