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General NPI Number Information
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NPI Number | 1598515009
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Entity Type | Organization
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Legal Business Name | ROSE CENTER FOR HEALING
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 10/26/2024
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Provider Practice Location Address
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Address Line | 611 WILSON AVE STE 6A
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City | POCATELLO
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State | ID
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Zip | 83201-5046
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Country | US
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Telephone | 208-254-5099
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Fax | 208-254-4180
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Provider Business Mailing Address
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Address Line | 611 WILSON AVE STE 6A
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City | POCATELLO
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State | ID
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Zip | 83201-5046
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Country | US
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Telephone | 208-254-5099
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Fax | 208-254-4180
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | PAISLEY ROSE CUMMINGS
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Credential | LCSW
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Telephone | 208-417-2218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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