Organization
COMMON ROOTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY L BROWN (CO -OWNER)
(719) 659-5271
Entity
Organization
Contact information
Practice address
805 S TEJON ST, COLORADO SPRINGS, CO 80903-4148
(719) 659-5271
Mailing address
805 S TEJON ST, COLORADO SPRINGS, CO 80903-4148
(719) 659-5271
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
09/11/2018
Last updated
01/07/2020
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