Healthcare Provider Details

I. General information

NPI: 1831997485
Provider Name (Legal Business Name): BETSY ROSS OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELSIE ST
ROME NY
13440-2556
US

IV. Provider business mailing address

1 ELSIE ST
ROME NY
13440-2556
US

V. Phone/Fax

Practice location:
  • Phone: 315-339-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: LIZER JOZEFOVIC
Title or Position: MANAGING MEMBER
Credential:
Phone: 845-222-1018