Provider Demographics
NPI:1124735014
Name:ROOTED COMMUNITIES LLC
Entity type:Organization
Organization Name:ROOTED COMMUNITIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-241-2969
Mailing Address - Street 1:446 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-2013
Mailing Address - Country:US
Mailing Address - Phone:563-241-2969
Mailing Address - Fax:
Practice Address - Street 1:145 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7111
Practice Address - Country:US
Practice Address - Phone:563-241-2969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347E00000XTransportation ServicesTransportation Broker