Provider Demographics
NPI:1902696735
Name:ROOTS OF REENTRY
Entity type:Organization
Organization Name:ROOTS OF REENTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LOVVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-561-9452
Mailing Address - Street 1:718 S MARIPOSA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2746
Mailing Address - Country:US
Mailing Address - Phone:720-561-9452
Mailing Address - Fax:
Practice Address - Street 1:718 S MARIPOSA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-2746
Practice Address - Country:US
Practice Address - Phone:720-561-9452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty