Healthcare Provider Details

I. General information

NPI: 1689972846
Provider Name (Legal Business Name): ROSEMARY CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 E GREEN ST
PASADENA CA
91107-3836
US

IV. Provider business mailing address

36 S KINNELOA AVE SUITE 200
PASADENA CA
91107-3853
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-7218
  • Fax:
Mailing address:
  • Phone: 626-844-3033
  • Fax: 626-844-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE ROMERO
Title or Position: WRAPAROUND PROGRAM DIRECTOR
Credential:
Phone: 626-844-3033