# ROOTED HEALTHCARE, LLC

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

## Provider details

- **NPI number:** 1891576591
- **Authorized official:** KISUN DEVON PETERS-DIAZ (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (917) 861-2531

## Contact information

- **Practice address:** 1106 BUSINESS PKWY S STE B, WESTMINSTER, MD 21157-3054
- **Practice address phone:** (410) 751-7771
- **Mailing address:** 405 N CENTER ST STE 25, WESTMINSTER, MD 21157-5126
- **Mailing address phone:** (917) 861-2531

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | — | NULL | — |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 10/09/2023
- **Last updated:** 10/09/2023