Provider Demographics
NPI:1063204121
Name:GRASSROOTS RECOVERY HOME SHARES LLC
Entity type:Organization
Organization Name:GRASSROOTS RECOVERY HOME SHARES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-524-4530
Mailing Address - Street 1:145 E KING ST
Mailing Address - Street 2:STE 201
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602
Mailing Address - Country:US
Mailing Address - Phone:301-524-4530
Mailing Address - Fax:301-524-4530
Practice Address - Street 1:525 S CHRISTIAN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4437
Practice Address - Country:US
Practice Address - Phone:301-524-4530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health