MEDICARE: ROSE RESIDENTIAL HEALTH 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	251C00000X	Developmentally Disabled Services Day Training Agency		OH

General Provider Information

NPI Number	:	1497191290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE RESIDENTIAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1290 E LONG ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1945
Country	:	US
Telephone Number	:	614-290-4425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1290 E LONG ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1945
Country	:	US
Telephone Number	:	614-290-4425
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DWEH-NAH KOLLIE
Credential	:
Telephone Number	:	614-290-4425

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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