Healthcare Provider Details

I. General information

NPI: 1851639405
Provider Name (Legal Business Name): ROSE GARDEN RESIDENTIAL OPERATOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WABASH AVE
MENTONE CA
92359-1124
US

IV. Provider business mailing address

4250 PENNSYLVANIA AVE SUITE 107
LA CRESCENTA CA
91214-3369
US

V. Phone/Fax

Practice location:
  • Phone: 909-794-1040
  • Fax: 909-389-9239
Mailing address:
  • Phone: 818-273-8900
  • Fax: 818-273-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MELYN CADABES
Title or Position: VP OF FINANCIAL SERVICES
Credential:
Phone: 818-273-8900