MEDICARE: ROSE GARDEN

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

General Provider Information

NPI Number	:	1982038402
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE GARDEN

Provider Business Mailing Address
First Line	:	1109 EMERYWOOD CT APT D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9041
Country	:	US
Telephone Number	:	702-517-0817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 EMERYWOOD CT
Second Line	:	UNIT D
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-9041
Country	:	US
Telephone Number	:	702-517-0817
Fax Number	:

Authorized Official
Title or Position	:	BAHAVIORAL ANALYST
Name	:	ROSEANNE ELLEEN PORTER
Credential	:
Telephone Number	:	702-517-0817

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	09/19/2013

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Directions to “ROSE GARDEN ” Practice Location

Language	Start Address	Practice Location

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