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NPI Code Detail

MEDICARE: ROOTED RECOVERY AND WELLNESS, LLC

MEDICARE: ROOTED RECOVERY AND WELLNESS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center
2101Y00000XCounselor
3106S00000XBehavior Technician
4133V00000XRegistered Dietitian
5251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1023735321
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROOTED RECOVERY AND WELLNESS, LLC
Provider Business Mailing Address
First Line : 85835 ALLBRITAIN LN
Second Line :
City : EUGENE
State : OR
Zip : 97405-8403
Country : US
Telephone Number : 541-972-1891
Fax Number :
Provider Business Practice Location Address
First Line : 5418 N EAGLE RD STE 160
Second Line :
City : BOISE
State : ID
Zip : 83713-0100
Country : US
Telephone Number : 541-844-3577
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : KATHERINE LYNN FRASER
Credential : MS, LPC
Telephone Number : 888-455-1642
Provider Enumeration Date : 10/26/2022
Last Update Date : 04/03/2024

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