Provider Demographics
NPI:1033634662
Name:ROCKS AND ROSES OPTIMAL HEALTH, LLC
Entity Type:Organization
Organization Name:ROCKS AND ROSES OPTIMAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:901-201-1963
Mailing Address - Street 1:6947 CRESTPOINT DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1753
Mailing Address - Country:US
Mailing Address - Phone:901-201-1963
Mailing Address - Fax:
Practice Address - Street 1:16915 SCUBA CREST ST
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2519
Practice Address - Country:US
Practice Address - Phone:901-201-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2023-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center