Provider Demographics
NPI:1437833886
Name:ROOTS WELLNESS COLLECTIVE, LLC
Entity Type:Organization
Organization Name:ROOTS WELLNESS COLLECTIVE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PIPER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRACH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:865-424-2628
Mailing Address - Street 1:268 S MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-5792
Mailing Address - Country:US
Mailing Address - Phone:865-424-2628
Mailing Address - Fax:
Practice Address - Street 1:268 S MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-5792
Practice Address - Country:US
Practice Address - Phone:865-424-2628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty