Provider Demographics
NPI:1851973770
Name:ALTARED ROOTS LLC
Entity Type:Organization
Organization Name:ALTARED ROOTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOULA
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:C-FSD
Authorized Official - Phone:301-467-5612
Mailing Address - Street 1:18225 1ST AVE S APT 221
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1885
Mailing Address - Country:US
Mailing Address - Phone:301-467-5612
Mailing Address - Fax:
Practice Address - Street 1:18225 1ST AVE S APT 221
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98148-1885
Practice Address - Country:US
Practice Address - Phone:301-467-5612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care