Organization
ROOTS COMMUNITY HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERUSHA NORMAN (COMPLIANCE ADMINISTRATOR)
(510) 994-6849
Entity
Organization
Contact information
Practice address
9925 INTERNATIONAL BLVD, #5, OAKLAND, CA 94603-2558
(510) 777-1177
Mailing address
9925 INTERNATIONAL BLVD, #5, OAKLAND, CA 94603-2558
(510) 777-1177
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
171W00000X
Contractor
—
—
251X00000X
Supports Brokerage Agency
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/23/2009
Last updated
04/05/2022
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