Healthcare Provider Details

I. General information

NPI: 1417323486
Provider Name (Legal Business Name): ROSEMARY HOME II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 SANTA ANA
CLOVIS CA
93611-9208
US

IV. Provider business mailing address

3354 GETTYSBURG AVE
CLOVIS CA
93619-5208
US

V. Phone/Fax

Practice location:
  • Phone: 559-291-1800
  • Fax:
Mailing address:
  • Phone: 559-291-1800
  • Fax: 559-291-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number107200829
License Number StateCA

VIII. Authorized Official

Name: MRS. CHANDRA G RAJ
Title or Position: OWNER
Credential:
Phone: 559-291-1800