Healthcare Provider Details

I. General information

NPI: 1700712999
Provider Name (Legal Business Name): ROSCROWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27503 N 25TH DR
PHOENIX AZ
85085-4723
US

IV. Provider business mailing address

27503 N 25TH DR
PHOENIX AZ
85085-4723
US

V. Phone/Fax

Practice location:
  • Phone: 702-445-8869
  • Fax:
Mailing address:
  • Phone: 702-445-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: EMILY IMONIEDAFE
Title or Position: NURSE MANGER
Credential: RN BSN
Phone: 702-445-8869