Provider Demographics
NPI:1851831309
Name:RESILIENT ROOTS LLC
Entity Type:Organization
Organization Name:RESILIENT ROOTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:JASPERS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:513-685-3504
Mailing Address - Street 1:55 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1813
Mailing Address - Country:US
Mailing Address - Phone:513-685-3504
Mailing Address - Fax:
Practice Address - Street 1:55 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1813
Practice Address - Country:US
Practice Address - Phone:513-685-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.15007761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty