MEDICARE: ROSEMARY CHILDREN'S SERVICES

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1346794906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEMARY CHILDREN'S SERVICES

Provider Business Mailing Address
First Line	:	1023 FREMONT AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3224
Country	:	US
Telephone Number	:	626-844-3033
Fax Number	:	626-844-3034

Provider Business Practice Location Address
First Line	:	1023 FREMONT AVE
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-3224
Country	:	US
Telephone Number	:	626-844-3033
Fax Number	:	626-844-3034

Authorized Official
Title or Position	:	COMMUNITY BASED SERVICES DIRECTOR
Name	:	LORRAINE ROMERO
Credential	:
Telephone Number	:	626-844-3033

Provider Enumeration Date	:	08/11/2016
Last Update Date	:	10/27/2016

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