| Rooted Healthcare, Llc | |
|
3101 Tyson Ave Philadelphia PA 19149-2031 | |
| (917) 861-2531 | |
| Not Available |
| Full Name | Rooted Healthcare, Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 3101 Tyson Ave, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Kisun Peters-diaz (EXECUTIVE DIRECTOR, FOUDNER) |
| Authorized Official Contact | 9178612531 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rooted Healthcare, Llc 4640 E Roosevelt Blvd Ste 31338 Philadelphia PA 19124-2300 Ph: (917) 861-2531 | Rooted Healthcare, Llc 3101 Tyson Ave Philadelphia PA 19149-2031 Ph: (917) 861-2531 |
| NPI Number | 1003514654 |
|---|---|
| Provider Enumeration Date | 02/22/2023 |
| Last Update Date | 05/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003514654 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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