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General NPI Number Information
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NPI Number | 1588261408
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Entity Type | Individual
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Provider Name | LAURA LARAINE ROSARIO
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Gender | Female
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Dates
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Enumeration Date | 10/04/2020
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Last Update Date | 10/04/2020
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Provider Practice Location Address
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Address Line | 1095 POPLAR ST
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City | NELSONVILLE
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State | OH
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Zip | 45764-1446
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Country | US
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Telephone | 740-221-0348
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Fax |
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Provider Business Mailing Address
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Address Line | 24 HOME ST APT 504
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City | ATHENS
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State | OH
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Zip | 45701-2070
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Country | US
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Telephone | 740-221-0348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 0221456
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License Number State | OH
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