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General NPI Number Information
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NPI Number | 1629487178
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Entity Type | Organization
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Legal Business Name | ROSA'S ASSISTED LIVING
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Dates
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Enumeration Date | 08/08/2014
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 5254 ROUND TABLE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78218-2826
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Country | US
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Telephone | 210-650-9963
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Fax |
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Provider Business Mailing Address
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Address Line | 7715 OAKHILL PARK DR
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City | SAN ANTONIO
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State | TX
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Zip | 78249-4455
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Country | US
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Telephone | 210-382-8788
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROSA L TONEY
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Credential | NURSE
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Telephone | 210-650-9963
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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 | 138374
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License Number State | TX
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