Provider Demographics
NPI:1851044903
Name:ROOTED EMPOWERMENT COLLECTIVE
Entity Type:Organization
Organization Name:ROOTED EMPOWERMENT COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-533-3837
Mailing Address - Street 1:1338 CENTER COURT DR STE 107
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3681
Mailing Address - Country:US
Mailing Address - Phone:626-275-8185
Mailing Address - Fax:
Practice Address - Street 1:1338 CENTER COURT DR STE 107
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3681
Practice Address - Country:US
Practice Address - Phone:626-275-8185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty