Healthcare Provider Details

I. General information

NPI: 1912415928
Provider Name (Legal Business Name): ROSECASTLE OF BRANDON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S LAKEWOOD DR
BRANDON FL
33511-0809
US

IV. Provider business mailing address

PO BOX 2568
HICKORY NC
28603-2568
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-8858
  • Fax:
Mailing address:
  • Phone: 828-322-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL9582
License Number StateFL

VIII. Authorized Official

Name: CHANTAL AUBE
Title or Position: PRESIDENT
Credential:
Phone: 727-480-1336