Organization
ROOTS RESIDENTIAL ADULT FAMILY HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERODD TAYLOR CPA MBA (OWNER)
(262) 880-5606
Entity
Organization
Contact information
Practice address
1715 LASALLE ST, RACINE, WI 53402-4824
(262) 902-3442
Mailing address
6210 BLUE RIVER WAY, RACINE, WI 53402-9448
(262) 880-5606
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0016022
WI
Other
Enumeration date
04/20/2016
Last updated
04/20/2016
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