Provider Demographics
NPI:1093074833
Name:ROSE'S AGENCY HOME CARE
Entity Type:Organization
Organization Name:ROSE'S AGENCY HOME CARE
Other - Org Name:THE GARY GROUP & ROSE'S TEMP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PESKIIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-937-3022
Mailing Address - Street 1:585 S. FAIRFAX AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036
Mailing Address - Country:US
Mailing Address - Phone:323-937-3022
Mailing Address - Fax:323-937-7167
Practice Address - Street 1:585 S. FAIRFAX AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:323-937-3022
Practice Address - Fax:323-937-7167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care