NPIMap

Organization Active NPI

Roots Residential Adult Family Homes LLC

  • Clinic/Center
  • Racine, WI
National Provider Identifier
1841644481
Registry record updated Apr 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
0016022 Issued in WI
Legal business name
ROOTS RESIDENTIAL ADULT FAMILY HOMES LLC
Practice address
1715 Lasalle St
Racine, WI 53402-4824
Phone
(262) 902-3442
NPI assigned
Apr 20, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2016

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

Authorized official

Name
Jerodd Taylor, CPA MBA
Title
Owner
Phone
(262) 880-5606

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 0016022 WI Primary

Addresses

Primary practice location

1715 Lasalle St
Racine, WI 53402-4824

Mailing address

6210 Blue River Way
Racine, WI 53402-9448
Phone (262) 880-5606

National Provider Directory

National Provider Directory
Tax ID family
Roots Residential Adult Family Home LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461110400000",
    "number": "1841644481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 BLUE RIVER WAY",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534029448",
            "telephone_number": "262-880-5606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 LASALLE ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534024824",
            "telephone_number": "262-902-3442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS RESIDENTIAL ADULT FAMILY HOMES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-20",
        "last_updated": "2016-04-20",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JERODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-880-5606",
        "authorized_official_credential": "CPA MBA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "0016022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2016; 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.