MEDICARE: AUGUST ROSE HEALTH CENTER, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1417891284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUGUST ROSE HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	7477 BALTIMORE ANNAPOLIS BLVD STE 205.206
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-3504
Country	:	US
Telephone Number	:	410-412-7791
Fax Number	:

Provider Business Practice Location Address
First Line	:	7477 BALTIMORE ANNAPOLIS BLVD STE 205.206
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-3504
Country	:	US
Telephone Number	:	410-412-7791
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DELLA RODERICK
Credential	:	LCPC
Telephone Number	:	410-412-7791

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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