Provider Demographics
NPI:1902659121
Name:RESILIENT ROOTS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:RESILIENT ROOTS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:785-301-1537
Mailing Address - Street 1:1260 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1815
Mailing Address - Country:US
Mailing Address - Phone:785-301-1537
Mailing Address - Fax:785-203-8439
Practice Address - Street 1:1260 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1815
Practice Address - Country:US
Practice Address - Phone:785-301-1537
Practice Address - Fax:785-203-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)