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General NPI Number Information
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NPI Number | 1902822182
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Entity Type | Organization
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Legal Business Name | ROSE TARA HOLDINGS, LLC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 125 PLANTATION DR
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City | KING
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State | NC
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Zip | 27021-9590
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Country | US
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Telephone | 336-983-8929
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Fax | 336-983-7424
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Provider Business Mailing Address
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Address Line | PO BOX 2568
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City | HICKORY
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State | NC
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Zip | 28603-2568
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Country | US
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Telephone | 828-322-5535
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Fax | 828-322-9587
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CHARLES E TREFZGER JR.
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Credential |
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Telephone | 828-322-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | HAL-085-008
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 7805465
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Identifier Type | MEDICAID
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Identifier State | NC
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 7805465
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Identifier Type | MEDICAID
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Identifier State | NC
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Identifier Issuer |
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