=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821728148
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSERICH FAMILY AND BEHAVIORAL HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2022
-----------------------------------------------------
Last Update Date | 12/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 BLAYDON CT
-----------------------------------------------------
City | ROSENBERG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77471-5687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-275-3391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 BLAYDON CT
-----------------------------------------------------
City | ROSENBERG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77471-5687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-275-3391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | HELEN ANYIAM
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 832-275-3391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------