# ROOTS & WINGS INDEPENDENT LIVING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336827153
- **Authorized official:** MS. TISHA NICOLE MCKENZIE PH.D. (FOUNDER/CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (973) 204-7775

## Contact information

- **Practice address:** 10 HEPWORTH PL, WEST ORANGE, NJ 07052-3206
- **Practice address phone:** (973) 204-7775
- **Mailing address:** 10 HEPWORTH PL, WEST ORANGE, NJ 07052-3206
- **Mailing address phone:** (973) 204-7775

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 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