MEDICARE: LATOYA LAVELLE ROSSER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	2573337	OH
2	251E00000X	Home Health Agency	0339942	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992187926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA LAVELLE ROSSER

Provider Business Mailing Address
First Line	:	5135 CARBONDALE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4522
Country	:	US
Telephone Number	:	614-375-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	5135 CARBONDALE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4522
Country	:	US
Telephone Number	:	614-375-0133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/22/2019

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