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: 05/14/2026
Certification Date: 05/14/2026
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 TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

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