Organization
NEW ROOTS RESIDENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA WANJA MUTHONI (OWNERADMINISTRATOR)
(480) 285-5483
Entity
Organization
Contact information
Practice address
3139 W CARSON RD, PHOENIX, AZ 85041-6342
(480) 285-5483
(602) 675-1560
Mailing address
3139 W CARSON RD, PHOENIX, AZ 85041-6342
(480) 285-5483
(602) 675-1560
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/06/2020
Last updated
02/06/2020
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