Organization
LIFE ROOTED FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARCUS HONG (ADMINISTRATOR)
(323) 646-2772
Entity
Organization
Contact information
Practice address
9436 S WESTERN AVE, LOS ANGELES, CA 90047-3856
(310) 591-8198
Mailing address
619 S FREMONT AVE STE C, ALHAMBRA, CA 91803-1337
(310) 591-8198
(866) 504-4012
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/01/2025
Last updated
11/01/2025
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