Healthcare Provider Details

I. General information

NPI: 1386506095
Provider Name (Legal Business Name): ROSEGARDEN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY APT 506
ALBANY NY
12207-2394
US

IV. Provider business mailing address

760 BROADWAY APT 506
ALBANY NY
12207-2394
US

V. Phone/Fax

Practice location:
  • Phone: 518-227-0850
  • Fax:
Mailing address:
  • Phone: 518-227-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: CORETTA E KILLIKELLY
Title or Position: OWNER
Credential: RN
Phone: 518-227-0850