# ROOTS RESIDENTIAL ADULT FAMILY HOME LLC

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

## Provider details

- **NPI number:** 1346790110
- **Authorized official:** MR. JERODD TAYLOR MBA CPA (OWNER)
- **Authorized official phone:** (262) 880-5606

## Contact information

- **Practice address:** 1715 LASALLE ST UPPR, RACINE, WI 53402-4824
- **Practice address phone:** (262) 800-1457
- **Practice address fax:** (262) 383-2131
- **Mailing address:** PO BOX 44035, RACINE, WI 53404-7001
- **Mailing address phone:** (262) 880-5606
- **Mailing address fax:** (262) 383-2131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | 0016034 | WI | Yes |

## Other

- **Enumeration date:** 10/05/2016
- **Last updated:** 10/05/2016