Organization
ROOTS RESIDENTIAL ADULT FAMILY HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERODD TAYLOR MBA CPA (OWNER)
(262) 880-5606
Entity
Organization
Contact information
Practice address
1715 LASALLE ST UPPR, RACINE, WI 53402-4824
(262) 800-1457
(262) 383-2131
Mailing address
PO BOX 44035, RACINE, WI 53404-7001
(262) 880-5606
(262) 383-2131
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
0016034
WI
Other
Enumeration date
10/05/2016
Last updated
10/05/2016
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