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General NPI Number Information
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NPI Number | 1033306360
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Entity Type | Organization
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Legal Business Name | THE ROSALIE FOUNDATION LLC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 772 SAINT GEORGE RD
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City | RALEIGH
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State | NC
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Zip | 27610-3757
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Country | US
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Telephone | 919-231-2826
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Fax | 919-654-7770
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Provider Business Mailing Address
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Address Line | 2532 MAYBROOK CROSSING DR
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City | RALEIGH
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State | NC
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Zip | 27610-3296
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Country | US
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Telephone | 919-231-2826
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Fax | 919-654-7770
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. SHANICKA LYNCH
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Credential |
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Telephone | 919-231-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | MHL-092-691
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License Number State | NC
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