=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780704346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSE OFSHARON HOME CARE AND HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1504 GILLESPIE ST # 1508
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-860-2058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1504 GILLESPIE ST # 1508
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28306-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-860-2058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. DOROTHY RENEE HENRY ROSS
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 910-860-2058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC2855
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------