Provider Demographics
NPI:1669063368
Name:MENDING ROOTS NATUROPATHY LLC
Entity type:Organization
Organization Name:MENDING ROOTS NATUROPATHY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LAC
Authorized Official - Phone:203-442-6297
Mailing Address - Street 1:2 RIMMONDALE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2931
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:117 RIVER ST UNIT B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3315
Practice Address - Country:US
Practice Address - Phone:203-442-6297
Practice Address - Fax:833-520-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1790226421Medicaid