Provider Demographics
NPI:1437957974
Name:GRASSROOTS HEALTH CARE INC
Entity type:Organization
Organization Name:GRASSROOTS HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FOLORUNSO
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-776-9911
Mailing Address - Street 1:7760 LANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2135
Mailing Address - Country:US
Mailing Address - Phone:305-619-1199
Mailing Address - Fax:
Practice Address - Street 1:7760 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2135
Practice Address - Country:US
Practice Address - Phone:305-619-1199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)