Healthcare Provider Details

I. General information

NPI: 1558487850
Provider Name (Legal Business Name): ROSEMARY CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 SOUTH KINNELOA AVE
PASADENA CA
91107-3853
US

IV. Provider business mailing address

36 SOUTH KINNELOA AVE
PASADENA CA
91107-3853
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberC0105864
License Number StateCA

VIII. Authorized Official

Name: MRS. JANA TREW
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 626-844-3033