Healthcare Provider Details

I. General information

NPI: 1235891003
Provider Name (Legal Business Name): ROSE GARDEN HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 NORTHSTAR DR
VILLA RICA GA
30180-5560
US

IV. Provider business mailing address

5378 SILVER WOODS WALK
POWDER SPRINGS GA
30127-9073
US

V. Phone/Fax

Practice location:
  • Phone: 678-538-8087
  • Fax:
Mailing address:
  • Phone: 678-549-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DONSONYA CUPRICE PATMON
Title or Position: BUSINESS PARTNER
Credential:
Phone: 678-538-8087