| Root And Bloom Wellness Llc | |
|
4867 E Beltline Ave Ne Grand Rapids MI 49525-9787 | |
| (616) 340-5617 | |
| Not Available |
| Full Name | Root And Bloom Wellness Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4867 E Beltline Ave Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Amber Faith Fox (OWNER/LEAD THERAPIST) |
| Authorized Official Contact | 6163405617 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Root And Bloom Wellness Llc 3090 Amon Ave Ne Grand Rapids MI 49525-3059 Ph: (616) 340-5617 | Root And Bloom Wellness Llc 4867 E Beltline Ave Ne Grand Rapids MI 49525-9787 Ph: (616) 340-5617 |
| NPI Number | 1386417590 |
|---|---|
| Provider Enumeration Date | 10/31/2023 |
| Last Update Date | 10/31/2023 |
| Certification Date | 10/31/2023 |
| Medicare PECOS PAC ID | 4789027871 |
|---|---|
| Medicare Enrollment ID | O20240206000991 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386417590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Amber Fox |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679279632 PECOS PAC ID: 0143670224 Enrollment ID: I20240102002757 |
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