Deep Roots Recovery LLC

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

Legal business name

DEEP ROOTS RECOVERY LLC

Practice address

1351 Page Dr S Ste 202
Fargo, ND 58103-3536

Phone

(701) 895-4353

NPI assigned

Mar 25, 2024

Last updated

Mar 25, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cole Ryan ThomsenNPI 1457110249

Title

President

Phone

(701) 895-4353

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cole Thomsen

  • Case Manager/Care Coordinator
  • Amenia, ND
  • NPI 1457110249
  NPD (past) Authorized official
• Ashley Bates

  • Case Manager/Care Coordinator
  • Amenia, ND
  • NPI 1821857616
  NPD (past)
• Keegan Murphy

  • Case Manager/Care Coordinator
  • Amenia, ND
  • NPI 1467211250
  NPD (past)
• Elizabeth Thomsen

  • Case Manager/Care Coordinator
  • Amenia, ND
  • NPI 1184483976
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1063262137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 PAGE DR S STE 202",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033536",
            "telephone_number": "701-895-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 PAGE DR S STE 202",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033536",
            "telephone_number": "701-895-4353"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15316 26th St SE",
            "address_purpose": "LOCATION",
            "city": "Amenia",
            "state": "ND",
            "postal_code": "580049753",
            "country_code": "US",
            "telephone_number": "701-895-4353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DEEP ROOTS RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-25",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "THOMSEN",
        "authorized_official_first_name": "COLE",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-895-4353"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alissa L Decoteau, LICSW
• Michelle Lee Decoteau
• Ervin Dedic
• Deep Roots LLC
• Deep Roots Recovery
• Brian K Dees, MD
• Adam John Defoe, M.D.
• Megan Tarryn Degenstein, LPCC
• Krissy Degroat
• Rachel Marie Dehoogh, APRN,CNP

• Peer Specialist in Fargo, ND
• Providers in Fargo, ND by specialty
• Peer Specialist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.