Provider Demographics
NPI:1821508169
Name:ROOT CAUSE LLC
Entity Type:Organization
Organization Name:ROOT CAUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSAOM LAC
Authorized Official - Phone:203-673-9600
Mailing Address - Street 1:422 TOILSOME HILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1627
Mailing Address - Country:US
Mailing Address - Phone:1203-673-9600
Mailing Address - Fax:
Practice Address - Street 1:75 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1226
Practice Address - Country:US
Practice Address - Phone:203-865-5121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-30
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1134577984Medicaid