MEDICARE: ROSE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1093667701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE HOME CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 105
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28402-0105
Country	:	US
Telephone Number	:	910-262-9067
Fax Number	:

Provider Business Practice Location Address
First Line	:	6821 CAMPBELLS RIDGE DR SE
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451-2037
Country	:	US
Telephone Number	:	910-262-9067
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TIFFANY WALKER
Credential	:
Telephone Number	:	910-262-9067

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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