Healthcare Provider Details

I. General information

NPI: 1760924062
Provider Name (Legal Business Name): ROSE GARDEN SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 SAN VICENTE RD
RAMONA CA
92065-3726
US

IV. Provider business mailing address

2138 SAN VICENTE RD
RAMONA CA
92065-3726
US

V. Phone/Fax

Practice location:
  • Phone: 858-668-9715
  • Fax:
Mailing address:
  • Phone: 858-668-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BRANDIE LEA CARGILE
Title or Position: OWNER
Credential: AA
Phone: 858-668-9715