MEDICARE: ROSETTA'S KEY

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	61621	TX

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	:	1689918591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSETTA'S KEY

Provider Business Mailing Address
First Line	:	8930 FOURWINDS DR
Second Line	:	SUITE 337
City	:	WINDCREST
State	:	TX
Zip	:	78239-1970
Country	:	US
Telephone Number	:	210-410-1595
Fax Number	:	210-590-0355

Provider Business Practice Location Address
First Line	:	8930 FOURWINDS DR
Second Line	:	SUITE 337
City	:	WINDCREST
State	:	TX
Zip	:	78239-1970
Country	:	US
Telephone Number	:	210-410-1595
Fax Number	:	210-590-0355

Authorized Official
Title or Position	:	OWNER
Name	:	VICTORIA ROSETTA JORDAN SPICER
Credential	:
Telephone Number	:	210-602-8793

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “ROSETTA'S KEY ” Practice Location

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