# LIVING ROOTS LLC

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

## Provider details

- **NPI number:** 1629467436
- **Authorized official:** BRIAN WILSON (OWNER/MANAGER)
- **Authorized official phone:** (616) 575-8519

## Contact information

- **Practice address:** 2850 THORNHILLS AVE SE, SUITE A, GRAND RAPIDS, MI 49546-7120
- **Practice address phone:** (616) 575-8519
- **Mailing address:** 2850 THORNHILLS AVE SE, SUITE A, GRAND RAPIDS, MI 49546-7120
- **Mailing address phone:** (616) 575-8519

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/16/2015
- **Last updated:** 01/16/2015