MEDICARE: REFINING ROOTS THERAPY 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1396687497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFINING ROOTS THERAPY LLC

Provider Business Mailing Address
First Line	:	6300 S CONNIE AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5736
Country	:	US
Telephone Number	:	605-359-3253
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 S CONNIE AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5736
Country	:	US
Telephone Number	:	605-359-3253
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIN RATCHFORD
Credential	:	CSW-PIP
Telephone Number	:	605-359-3253

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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