# ROOTS RESIDENTIAL ADULT FAMILY HOMES LLC

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

## Provider details

- **NPI number:** 1841644481
- **Authorized official:** JERODD TAYLOR CPA MBA (OWNER)
- **Authorized official phone:** (262) 880-5606

## Contact information

- **Practice address:** 1715 LASALLE ST, RACINE, WI 53402-4824
- **Practice address phone:** (262) 902-3442
- **Mailing address:** 6210 BLUE RIVER WAY, RACINE, WI 53402-9448
- **Mailing address phone:** (262) 880-5606

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 0016022 | WI | Yes |

## Other

- **Enumeration date:** 04/20/2016
- **Last updated:** 04/20/2016