Healthcare Provider Details

I. General information

NPI: 1972096196
Provider Name (Legal Business Name): ROSE OF SHARON OF CENTRAL FL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 W NORTH BLVD STE 3
LEESBURG FL
34748-3997
US

IV. Provider business mailing address

PO BOX 490854
LEESBURG FL
34749-0854
US

V. Phone/Fax

Practice location:
  • Phone: 352-255-4060
  • Fax:
Mailing address:
  • Phone: 352-255-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. FRAZIER JEROME MARSHALL
Title or Position: ADMINISTRATOR
Credential:
Phone: 352-255-4060