Healthcare Provider Details

I. General information

NPI: 1144117433
Provider Name (Legal Business Name): BLU ROSES GARDEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 JUNCTION RD
MOCKSVILLE NC
27028-5324
US

IV. Provider business mailing address

1116 JUNCTION RD
MOCKSVILLE NC
27028-5324
US

V. Phone/Fax

Practice location:
  • Phone: 336-791-6556
  • Fax:
Mailing address:
  • Phone: 336-791-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHAMIKA YOLANDA POMPEY
Title or Position: OWNER/EXECUTIVE DIRECTOR
Credential: MSW, LCSW-A
Phone: 336-791-6556