Provider Demographics
NPI:1144739764
Name:ROOTS HEALTHCARE AND HOMES, LLC
Entity type:Organization
Organization Name:ROOTS HEALTHCARE AND HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MEDICAL MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN CCM
Authorized Official - Phone:760-270-3791
Mailing Address - Street 1:292 PICKENS CIR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-7982
Mailing Address - Country:US
Mailing Address - Phone:760-270-3791
Mailing Address - Fax:
Practice Address - Street 1:1150 SAUNDERS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-5229
Practice Address - Country:US
Practice Address - Phone:760-270-3791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X, 261QR0404X, 310400000X, 3104A0630X, 385H00000X, 311Z00000X, 311ZA0620X, 343900000X, 174200000X, 177F00000X, 251G00000X, 251J00000X
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No385H00000XRespite Care FacilityRespite Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
4785231OtherNO NUMBER