Provider Demographics
NPI:1083258461
Name:ROOTED COMMUNITY ACUPUNCTURE, INC
Entity Type:Organization
Organization Name:ROOTED COMMUNITY ACUPUNCTURE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:480-336-3504
Mailing Address - Street 1:12810 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-6507
Mailing Address - Country:US
Mailing Address - Phone:602-758-1235
Mailing Address - Fax:
Practice Address - Street 1:3133 E GREENWAY RD STE 505
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4480
Practice Address - Country:US
Practice Address - Phone:480-336-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty