Provider Demographics
NPI:1114357787
Name:ROSEWAYNE HEALTH SERVICES & HOME CARE
Entity Type:Organization
Organization Name:ROSEWAYNE HEALTH SERVICES & HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENTROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-373-9605
Mailing Address - Street 1:6239 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4736
Mailing Address - Country:US
Mailing Address - Phone:407-373-9605
Mailing Address - Fax:321-206-9704
Practice Address - Street 1:6239 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4736
Practice Address - Country:US
Practice Address - Phone:407-373-9605
Practice Address - Fax:321-206-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211448251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid