Healthcare Provider Details

I. General information

NPI: 1669294260
Provider Name (Legal Business Name): ROSE HOME HEALTH CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2024
Last Update Date: 11/03/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 GLENLEA DR
WILMINGTON NC
28405-2203
US

IV. Provider business mailing address

PO BOX 105
WILMINGTON NC
28402-0105
US

V. Phone/Fax

Practice location:
  • Phone: 910-262-9067
  • Fax: 910-253-9844
Mailing address:
  • Phone: 910-262-9067
  • Fax: 910-253-9844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: TIFFANY TANI WALKER
Title or Position: OWNER
Credential: CPSS
Phone: 910-262-9067