Healthcare Provider Details

I. General information

NPI: 1083782593
Provider Name (Legal Business Name): RED ROSES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 N MAPLE GROVE RD
BOISE ID
83704-5663
US

IV. Provider business mailing address

2525 N MAPLE GROVE RD
BOISE ID
83704-5663
US

V. Phone/Fax

Practice location:
  • Phone: 208-375-2564
  • Fax:
Mailing address:
  • Phone: 208-375-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberRC-599
License Number StateID

VIII. Authorized Official

Name: MS. RHONDA E REPP
Title or Position: OWNER, ADMINISTRATOR
Credential:
Phone: 208-375-2564