Provider Demographics
NPI:1194522136
Name:ROOTS TO BLOOMS LLC
Entity type:Organization
Organization Name:ROOTS TO BLOOMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAFSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAHUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-415-1578
Mailing Address - Street 1:4901 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3938
Mailing Address - Country:US
Mailing Address - Phone:202-415-1578
Mailing Address - Fax:
Practice Address - Street 1:4901 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3938
Practice Address - Country:US
Practice Address - Phone:202-415-1578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health