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Organization
ROOTED LIFE
Active
Organization
ROOTED LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACEY WILSON (CHIEF EXECUTIVE OFFICER)
(619) 357-6472
Entity
Organization
Contact information
Practice address
6315 CONNIE DR, SAN DIEGO, CA 92115-2521
(619) 915-4186
(619) 810-9201
Mailing address
864 GRAND AVE # 802, SAN DIEGO, CA 92109-3906
(619) 648-1600
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/21/2023
Last updated
08/06/2024
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