Healthcare Provider Details

I. General information

NPI: 1003407099
Provider Name (Legal Business Name): ROSE IN-HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W AZTEC AVE
GALLUP NM
87301-6516
US

IV. Provider business mailing address

606 W AZTEC AVE
GALLUP NM
87301-6516
US

V. Phone/Fax

Practice location:
  • Phone: 505-728-5653
  • Fax:
Mailing address:
  • Phone: 505-728-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA CHEE
Title or Position: OWNER
Credential:
Phone: 505-728-5653