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General NPI Number Information
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NPI Number | 1730666082
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Entity Type | Organization
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Legal Business Name | ROSES PLACE OF CARE INC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 1233 DUNBROOKE ST
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4859
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Country | US
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Telephone | 407-287-7149
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Fax |
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Provider Business Mailing Address
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Address Line | 1233 DUNBROOKE ST
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City | WINTER GARDEN
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State | FL
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Zip | 34787-4859
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Country | US
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Telephone | 407-287-7149
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROSALYN LACY
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Credential |
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Telephone | 407-287-7149
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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 | 6906651
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License Number State | FL
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