MEDICARE: AMANA ROSE ,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	314000000X	Skilled Nursing Facility	114145	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	:	1700889599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMANA ROSE ,LLC

Provider Business Mailing Address
First Line	:	225 N SOWERS RD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-7449
Country	:	US
Telephone Number	:	972-253-4173
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 N SOWERS RD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75061-7449
Country	:	US
Telephone Number	:	806-771-4124
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHERRILL ANN SLAYTON
Credential	:
Telephone Number	:	972-253-4173

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/22/2020

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Directions to “AMANA ROSE ,LLC ” Practice Location

Language	Start Address	Practice Location

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