Provider Demographics
NPI:1750128583
Name:RIGHTEOUS ROOTS
Entity type:Organization
Organization Name:RIGHTEOUS ROOTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:214-995-3970
Mailing Address - Street 1:3833 CONDOR STOOP DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4294
Mailing Address - Country:US
Mailing Address - Phone:214-995-3970
Mailing Address - Fax:
Practice Address - Street 1:3833 CONDOR STOOP DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4294
Practice Address - Country:US
Practice Address - Phone:214-995-3970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities