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General NPI Number Information
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NPI Number | 1083782593
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Entity Type | Organization
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Legal Business Name | RED ROSES
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 2525 N MAPLE GROVE RD
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City | BOISE
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State | ID
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Zip | 83704-5663
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Country | US
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Telephone | 208-375-2564
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 N MAPLE GROVE RD
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City | BOISE
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State | ID
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Zip | 83704-5663
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Country | US
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Telephone | 208-375-2564
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Fax |
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR
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Name | MS. RHONDA E REPP
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Credential |
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Telephone | 208-375-2564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | RC-599
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License Number State | ID
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