Provider Demographics
NPI:1851158489
Name:BARE ROOTS WELLNESS, LLC
Entity Type:Organization
Organization Name:BARE ROOTS WELLNESS, LLC
Other - Org Name:BARE ROOTS NURSE COACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-560-4222
Mailing Address - Street 1:13101 PRESTON RD STE 210-282
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5237
Mailing Address - Country:US
Mailing Address - Phone:214-560-4222
Mailing Address - Fax:
Practice Address - Street 1:13101 PRESTON RD STE 110-282
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5237
Practice Address - Country:US
Practice Address - Phone:214-560-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty