Provider Demographics
NPI:1568284040
Name:ROOTED HEALTHCARE LLC
Entity type:Organization
Organization Name:ROOTED HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TWALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-779-9298
Mailing Address - Street 1:16513 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1748
Mailing Address - Country:US
Mailing Address - Phone:636-779-9296
Mailing Address - Fax:
Practice Address - Street 1:100 S 4TH ST STE 550
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63102-1897
Practice Address - Country:US
Practice Address - Phone:636-779-9296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health