Provider Demographics
NPI:1417398132
Name:ROOTED IN HEALTH
Entity Type:Organization
Organization Name:ROOTED IN HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAILINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WISOFF
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:303-249-8061
Mailing Address - Street 1:503 E EMMA ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2230
Mailing Address - Country:US
Mailing Address - Phone:303-249-8061
Mailing Address - Fax:303-926-0586
Practice Address - Street 1:8774 YATES DR
Practice Address - Street 2:SUITE 350
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6958
Practice Address - Country:US
Practice Address - Phone:303-249-8061
Practice Address - Fax:303-926-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17028Medicare PIN