Provider Demographics
NPI:1699552224
Name:ROOTED FAMILY WELLNESS LLC
Entity type:Organization
Organization Name:ROOTED FAMILY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MACE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:603-759-6601
Mailing Address - Street 1:105 GUYS WAY
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1266
Mailing Address - Country:US
Mailing Address - Phone:603-759-6601
Mailing Address - Fax:
Practice Address - Street 1:2 SOUTHSIDE RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-5117
Practice Address - Country:US
Practice Address - Phone:603-759-6601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty