Provider Demographics
NPI:1285959809
Name:ROOTED AND GROUNDED, INC.
Entity type:Organization
Organization Name:ROOTED AND GROUNDED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-332-4409
Mailing Address - Street 1:124 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-3416
Mailing Address - Country:US
Mailing Address - Phone:252-332-4409
Mailing Address - Fax:
Practice Address - Street 1:116 EAST GRUBB STREET
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-1181
Practice Address - Country:US
Practice Address - Phone:252-426-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care