Provider Demographics
NPI:1306441738
Name:ROOTED IN NATURE HEALTH CARE FACILITY LLC
Entity type:Organization
Organization Name:ROOTED IN NATURE HEALTH CARE FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-957-5366
Mailing Address - Street 1:17905 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6507
Mailing Address - Country:US
Mailing Address - Phone:503-957-5366
Mailing Address - Fax:
Practice Address - Street 1:17905 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6507
Practice Address - Country:US
Practice Address - Phone:503-957-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing