Provider Demographics
NPI:1952942575
Name:ROOTS COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:ROOTS COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ABOELATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-777-1177
Mailing Address - Street 1:9925 INTERNATIONAL BLVD #5
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-2558
Mailing Address - Country:US
Mailing Address - Phone:510-777-1177
Mailing Address - Fax:510-550-2644
Practice Address - Street 1:583 5TH ST STE A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:510-839-0929
Practice Address - Fax:510-788-6837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROOTS COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty