Provider Demographics
NPI:1124782016
Name:ROOT OF IT LLC
Entity type:Organization
Organization Name:ROOT OF IT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:402-215-7327
Mailing Address - Street 1:11580 W DODGE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2537
Mailing Address - Country:US
Mailing Address - Phone:402-238-1431
Mailing Address - Fax:402-281-1862
Practice Address - Street 1:11580 W DODGE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2537
Practice Address - Country:US
Practice Address - Phone:402-238-1431
Practice Address - Fax:402-281-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty