Provider Demographics
NPI:1164122826
Name:ROOTS FOOD GROUP MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ROOTS FOOD GROUP MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-277-8525
Mailing Address - Street 1:106 DECKER CT STE 260
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2380
Mailing Address - Country:US
Mailing Address - Phone:888-277-8525
Mailing Address - Fax:833-444-6325
Practice Address - Street 1:106 DECKER CT STE 260
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2380
Practice Address - Country:US
Practice Address - Phone:888-277-8528
Practice Address - Fax:833-444-6325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROOTS FOOD GROUP HOLDINGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals