Provider Demographics
NPI:1508517855
Name:ROOTED LIVING LLC
Entity Type:Organization
Organization Name:ROOTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORALE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAOR
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:201-566-4831
Mailing Address - Street 1:20-21 WAGARAW ROAD
Mailing Address - Street 2:SUITE 34
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410
Mailing Address - Country:US
Mailing Address - Phone:201-566-4831
Mailing Address - Fax:
Practice Address - Street 1:20-21 WAGARAW ROAD
Practice Address - Street 2:SUITE 34
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410
Practice Address - Country:US
Practice Address - Phone:201-566-4831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty