MEDICARE: ROSE OF SHARON MEDICAL 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1538250634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE OF SHARON MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	2125 MCCULLOCH BLVD N
Second Line	:	STE B
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5899
Country	:	US
Telephone Number	:	928-855-8655
Fax Number	:	928-505-4653

Provider Business Practice Location Address
First Line	:	2125 MCCULLOCH BLVD
Second Line	:	STE B
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5899
Country	:	US
Telephone Number	:	928-855-8655
Fax Number	:	928-505-4653

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CAROLYN ANN RIBAUDO
Credential	:
Telephone Number	:	928-855-8655

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	02/25/2008

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Directions to “ROSE OF SHARON MEDICAL SERVICES ” Practice Location

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