Provider Demographics
NPI:1851182794
Name:SIMPLE ROOTS NUTRITION LLC
Entity type:Organization
Organization Name:SIMPLE ROOTS NUTRITION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:660-281-8849
Mailing Address - Street 1:811 WARWICK AVE APT 5L
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-2600
Mailing Address - Country:US
Mailing Address - Phone:660-281-8849
Mailing Address - Fax:
Practice Address - Street 1:811 WARWICK AVE APT 5L
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-2600
Practice Address - Country:US
Practice Address - Phone:660-281-8849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty