# LIVING ROOTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Leaves Personal Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487071213
- **Authorized official:** MR. BRIAN WILSON (OWNER/MANAGER)
- **Authorized official phone:** (616) 575-8519

## Contact information

- **Practice address:** 3980 CHICAGO DR SW, SUITE 100, GRANDVILLE, MI 49418-1392
- **Practice address phone:** (616) 575-8519
- **Practice address fax:** (616) 575-9078
- **Mailing address:** 3980 CHICAGO DR SW, SUITE 100, GRANDVILLE, MI 49418-1392
- **Mailing address phone:** (616) 575-8519
- **Mailing address fax:** (616) 575-9078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/18/2014
- **Last updated:** 05/25/2016