Provider Demographics
NPI:1003036534
Name:JENNA ROSE, INC.
Entity Type:Organization
Organization Name:JENNA ROSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HIRATZKA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC
Authorized Official - Phone:970-518-5757
Mailing Address - Street 1:7205 POUDRE RIVER RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9375
Mailing Address - Country:US
Mailing Address - Phone:970-518-5757
Mailing Address - Fax:
Practice Address - Street 1:804 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3246
Practice Address - Country:US
Practice Address - Phone:970-518-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC-6686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty