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Organization
ROOTS & WINGS INDEPENDENT LIVING
Active
Organization
ROOTS & WINGS INDEPENDENT LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TISHA NICOLE MCKENZIE PH.D. (FOUNDER/CHIEF EXECUTIVE OFFICER)
(973) 204-7775
Entity
Organization
Contact information
Practice address
10 HEPWORTH PL, WEST ORANGE, NJ 07052-3206
(973) 204-7775
Mailing address
10 HEPWORTH PL, WEST ORANGE, NJ 07052-3206
(973) 204-7775
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
Primary
—
NULL
305R00000X
Preferred Provider Organization
—
NULL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
NULL
385H00000X
Respite Care
—
NULL
Other
Enumeration date
07/11/2023
Last updated
07/11/2023
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