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Organization
ROOTS RESIDENTIAL ADULT FAMILY HOME LLC
Active
Organization
ROOTS RESIDENTIAL ADULT FAMILY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERODD TAYLOR MBA CPA (OWNER)
(262) 880-5606
Entity
Organization
Contact information
Practice address
1715 LASALLE ST UPPR, RACINE, WI 53402-4824
(262) 800-1457
(262) 383-2131
Mailing address
PO BOX 44035, RACINE, WI 53404-7001
(262) 880-5606
(262) 383-2131
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
0016034
WI
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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