Provider Demographics
NPI:1366258386
Name:ROOTS OF RESILIENCE CHILD AND FAMILY CENTER LLC
Entity type:Organization
Organization Name:ROOTS OF RESILIENCE CHILD AND FAMILY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-707-8150
Mailing Address - Street 1:PO BOX 65264
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87193-5264
Mailing Address - Country:US
Mailing Address - Phone:505-585-1348
Mailing Address - Fax:
Practice Address - Street 1:7809 RIDGEVIEW DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2880
Practice Address - Country:US
Practice Address - Phone:505-585-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty