Provider Demographics
NPI:1649162652
Name:ROOTEAD ENRICHMENT CENTER
Entity type:Organization
Organization Name:ROOTEAD ENRICHMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RED BIRTH GREEN MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:CD
Authorized Official - Phone:269-370-8392
Mailing Address - Street 1:505 E KALAMAZOO AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3873
Mailing Address - Country:US
Mailing Address - Phone:269-720-9200
Mailing Address - Fax:
Practice Address - Street 1:505 E KALAMAZOO AVE STE 3
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3873
Practice Address - Country:US
Practice Address - Phone:269-720-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty