Provider Demographics
NPI:1083782593
Name:RED ROSES
Entity Type:Organization
Organization Name:RED ROSES
Other - Org Name:VIRGINIA ROSE RESIDENT INN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:REPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-2564
Mailing Address - Street 1:2525 N MAPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5663
Mailing Address - Country:US
Mailing Address - Phone:208-375-2564
Mailing Address - Fax:
Practice Address - Street 1:2525 N MAPLE GROVE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5663
Practice Address - Country:US
Practice Address - Phone:208-375-2564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-5993104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness