Organization
ROOTS4CHANGE COOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER VALENCIA (PRESIDENT)
(704) 884-5284
Entity
Organization
Contact information
Practice address
701 E WASHINGTON AVE STE 102, MADISON, WI 53703-2958
(904) 385-8151
Mailing address
701 E WASHINGTON AVE STE 102, MADISON, WI 53703-2958
(904) 385-8151
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/11/2024
Last updated
09/11/2024
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