Healthcare Provider Details

I. General information

NPI: 1376472746
Provider Name (Legal Business Name): RATTLERS ROSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875A ISLAND DR # 252
ALAMEDA CA
94502-6751
US

IV. Provider business mailing address

875A ISLAND DR # 252
ALAMEDA CA
94502-6751
US

V. Phone/Fax

Practice location:
  • Phone: 470-783-1829
  • Fax:
Mailing address:
  • Phone: 470-783-1829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIERRA RENEE POETIC TYLER
Title or Position: MANAGER/ CARE COORDINATOR
Credential: CCMA, CNA
Phone: 470-783-1829