Provider Demographics
NPI:1083452247
Name:SOLID ROOTS FOUNDTION
Entity type:Organization
Organization Name:SOLID ROOTS FOUNDTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YANNICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-930-2160
Mailing Address - Street 1:219 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-4368
Mailing Address - Country:US
Mailing Address - Phone:910-930-2160
Mailing Address - Fax:
Practice Address - Street 1:219 WINDSOR DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4368
Practice Address - Country:US
Practice Address - Phone:910-930-2160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness