Provider Demographics
NPI:1609468347
Name:LOCAL ROOTS HEALTH CARE, PLLC
Entity Type:Organization
Organization Name:LOCAL ROOTS HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ANDERS
Authorized Official - Last Name:HOLMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:207-929-0170
Mailing Address - Street 1:75 FOREST ST
Mailing Address - Street 2:C/O KYLE HOLMQUIST
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:207-929-0170
Mailing Address - Fax:
Practice Address - Street 1:12 DEPOT ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7038
Practice Address - Country:US
Practice Address - Phone:207-569-2021
Practice Address - Fax:207-203-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service