MEDICARE: ERNEST H ROSSER FOUNDATION, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487191672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNEST H ROSSER FOUNDATION, LLC

Provider Business Mailing Address
First Line	:	25 SUMMIT RD
Second Line	:
City	:	LITTLETON
State	:	NC
Zip	:	27850-9673
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 SUMMIT RD
Second Line	:
City	:	LITTLETON
State	:	NC
Zip	:	27850-9673
Country	:	US
Telephone Number	:	252-578-8121
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEMETRIA ROSSER
Credential	:
Telephone Number	:	252-578-8121

Provider Enumeration Date	:	01/25/2017
Last Update Date	:	01/25/2017

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