MEDICARE: HEALING ROOTS MATERNAL ALLIANCE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	104100000X	Social Worker
3	163W00000X	Registered Nurse
4	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1275322687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING ROOTS MATERNAL ALLIANCE

Provider Business Mailing Address
First Line	:	4343 SHADY BEND DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-7448
Country	:	US
Telephone Number	:	682-326-9662
Fax Number	:

Provider Business Practice Location Address
First Line	:	4343 SHADY BEND DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-7448
Country	:	US
Telephone Number	:	682-326-9662
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/DIRECTOR
Name	:	JAZMINE LINDA GONZALEZ
Credential	:	RN
Telephone Number	:	682-326-9662

Provider Enumeration Date	:	05/02/2025
Last Update Date	:	05/02/2025

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Directions to “HEALING ROOTS MATERNAL ALLIANCE ” Practice Location

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