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General NPI Number Information
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NPI Number | 1922958008
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Entity Type | Organization
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Legal Business Name | ROOTED BEGINNINGS LLC
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 532 INDIAN TRL
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City | TAYLORS
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State | SC
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Zip | 29687-4940
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Country | US
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Telephone | 704-609-2788
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Fax | 864-428-0577
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Provider Business Mailing Address
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Address Line | 532 INDIAN TRL
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City | TAYLORS
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State | SC
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Zip | 29687-4940
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Country | US
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Telephone | 704-609-2788
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Fax | 864-428-0577
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Authorized Official
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Title or Position | OWNER
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Name | AVERY PARKER ELLENBURG-MARLOW
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Credential |
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Telephone | 704-609-2788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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