| Roots Residential Adult Family Homes Llc | |
|
1715 Lasalle St Racine WI 53402-4824 | |
| (262) 902-3442 | |
| Not Available |
| Full Name | Roots Residential Adult Family Homes Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 1715 Lasalle St, Racine, Wisconsin |
| Authorized Official Name and Position | Jerodd Taylor (OWNER) |
| Authorized Official Contact | 2628805606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roots Residential Adult Family Homes Llc 6210 Blue River Way Racine WI 53402-9448 Ph: (262) 880-5606 | Roots Residential Adult Family Homes Llc 1715 Lasalle St Racine WI 53402-4824 Ph: (262) 902-3442 |
| NPI Number | 1841644481 |
|---|---|
| Provider Enumeration Date | 04/20/2016 |
| Last Update Date | 04/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841644481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0016022 (Wisconsin) | Primary |
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