Healthcare Provider Details

I. General information

NPI: 1235049214
Provider Name (Legal Business Name): BLUE ROSE COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 SAN ANSELINE AVE
LONG BEACH CA
90808-2729
US

IV. Provider business mailing address

3435 SAN ANSELINE AVE
LONG BEACH CA
90808-2729
US

V. Phone/Fax

Practice location:
  • Phone: 562-230-3112
  • Fax:
Mailing address:
  • Phone: 562-230-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: LANCE TERRELL RILEY
Title or Position: PRESIDENT
Credential:
Phone: 562-230-3112