Healthcare Provider Details

I. General information

NPI: 1699765958
Provider Name (Legal Business Name): ROSE & WELLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 12TH ST
RUSSELLVILLE AR
72801-6606
US

IV. Provider business mailing address

900 W 12TH ST
RUSSELLVILLE AR
72801-6606
US

V. Phone/Fax

Practice location:
  • Phone: 479-968-5858
  • Fax: 479-890-6013
Mailing address:
  • Phone: 479-968-5858
  • Fax: 479-890-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number037
License Number StateAR

VIII. Authorized Official

Name: MS. REBECCA BRASHEAR
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 479-968-5858