Provider Demographics
NPI:1285065375
Name:ROUNDTREE, RAKEIA (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:MS
First Name:RAKEIA
Middle Name:
Last Name:ROUNDTREE
Suffix:
Gender:
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3333
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-0333
Mailing Address - Country:US
Mailing Address - Phone:419-326-5535
Mailing Address - Fax:
Practice Address - Street 1:1119 W BANCROFT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4613
Practice Address - Country:US
Practice Address - Phone:419-326-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-28
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X, 385H00000X, 104100000X
OH401238240511376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid