Provider Demographics
NPI:1356238802
Name:ROOTED HEART LLC
Entity type:Organization
Organization Name:ROOTED HEART LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LETISHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYTCH
Authorized Official - Suffix:
Authorized Official - Credentials:BSHEALTHCARE ADMIN
Authorized Official - Phone:856-246-2926
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-0028
Mailing Address - Country:US
Mailing Address - Phone:856-246-2926
Mailing Address - Fax:
Practice Address - Street 1:310 N 31ST ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-1418
Practice Address - Country:US
Practice Address - Phone:856-308-5088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health