Healthcare Provider Details

I. General information

NPI: 1467372433
Provider Name (Legal Business Name): MONARCH ROSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4537 N HIGHWAY 61
PERRYVILLE MO
63775-8436
US

IV. Provider business mailing address

4537 N HIGHWAY 61
PERRYVILLE MO
63775-8436
US

V. Phone/Fax

Practice location:
  • Phone: 573-768-1902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: MAKENZIE MCCLAIN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 573-768-1902