Provider Demographics
NPI:1215726708
Name:ROOTED HEALTHCARE, LLC
Entity type:Organization
Organization Name:ROOTED HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KISUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-861-2531
Mailing Address - Street 1:1 DAUBER CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1443
Mailing Address - Country:US
Mailing Address - Phone:443-240-4471
Mailing Address - Fax:
Practice Address - Street 1:1106 BUSINESS PARKWAY SOUTH
Practice Address - Street 2:SUITE B
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:917-861-2531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care