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General NPI Number Information
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NPI Number | 1902696735
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Entity Type | Organization
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Legal Business Name | ROOTS OF REENTRY
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 718 S MARIPOSA WAY
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City | DENVER
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State | CO
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Zip | 80223-2746
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Country | US
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Telephone | 720-561-9452
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Fax |
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Provider Business Mailing Address
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Address Line | 718 S MARIPOSA WAY
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City | DENVER
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State | CO
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Zip | 80223-2746
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Country | US
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Telephone | 720-561-9452
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | LOVVIE SANDOVAL
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Credential |
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Telephone | 720-561-9452
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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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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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