Provider Demographics
NPI:1710706924
Name:OUR ROOTS
Entity type:Organization
Organization Name:OUR ROOTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-946-0283
Mailing Address - Street 1:1311 PARK ST # 1020
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4507
Mailing Address - Country:US
Mailing Address - Phone:510-946-0283
Mailing Address - Fax:
Practice Address - Street 1:4047 HARDING WAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1919
Practice Address - Country:US
Practice Address - Phone:510-946-0283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-04
Last Update Date:2024-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker