Provider Demographics
NPI:1104309434
Name:ROOTS RECOVERY
Entity type:Organization
Organization Name:ROOTS RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-991-2885
Mailing Address - Street 1:393 DUNLAP ST N STE 736
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4205
Mailing Address - Country:US
Mailing Address - Phone:612-289-5656
Mailing Address - Fax:651-925-0278
Practice Address - Street 1:393 DUNLAP ST N STE 736
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4205
Practice Address - Country:US
Practice Address - Phone:612-289-5656
Practice Address - Fax:651-925-0278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINNESOTA CAREPARTNER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder