MEDICARE: ROSES ADULT CARE SERVICE

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	3140N1450X	Pediatric Skilled Nursing Facility

General Provider Information

NPI Number	:	1659792133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSES ADULT CARE SERVICE

Provider Business Mailing Address
First Line	:	1617 TREE RIDGE RD
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-6894
Country	:	US
Telephone Number	:	804-651-6654
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 NOBLE AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2525
Country	:	US
Telephone Number	:	804-651-6654
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MRS. PAMELA LYNNE STITH
Credential	:	RN
Telephone Number	:	804-651-6654

Provider Enumeration Date	:	12/30/2013
Last Update Date	:	12/30/2013

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