Provider Demographics
NPI:1083147789
Name:ROSE TERRACE OF FLORIDA
Entity Type:Organization
Organization Name:ROSE TERRACE OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIERGELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVARISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-517-4264
Mailing Address - Street 1:2872 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5962
Mailing Address - Country:US
Mailing Address - Phone:239-571-4264
Mailing Address - Fax:
Practice Address - Street 1:2872 GORDON ST
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5962
Practice Address - Country:US
Practice Address - Phone:239-571-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities