Provider Demographics
NPI:1083419808
Name:ROOTS CARE LIVING LLC
Entity type:Organization
Organization Name:ROOTS CARE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NYIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBOE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-617-4334
Mailing Address - Street 1:9719 BROOKS BEND RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-4625
Mailing Address - Country:US
Mailing Address - Phone:903-617-4334
Mailing Address - Fax:
Practice Address - Street 1:9719 BROOKS BEND RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-4625
Practice Address - Country:US
Practice Address - Phone:903-617-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health