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General NPI Number Information
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NPI Number | 1972096196
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Entity Type | Organization
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Legal Business Name | ROSE OF SHARON OF CENTRAL FL INC
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 1326 W NORTH BLVD STE 3
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City | LEESBURG
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State | FL
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Zip | 34748-3997
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Country | US
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Telephone | 352-255-4060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 490854
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City | LEESBURG
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State | FL
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Zip | 34749-0854
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Country | US
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Telephone | 352-255-4060
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FRAZIER JEROME MARSHALL
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Credential |
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Telephone | 352-255-4060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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