Provider Demographics
NPI:1114513074
Name:ROSE VILLA ASSISTED LIVING HOME I
Entity Type:Organization
Organization Name:ROSE VILLA ASSISTED LIVING HOME I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASALEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-299-0926
Mailing Address - Street 1:5240 W DESERT HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-4404
Mailing Address - Country:US
Mailing Address - Phone:480-299-0926
Mailing Address - Fax:
Practice Address - Street 1:5240 W DESERT HOLLOW DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-4404
Practice Address - Country:US
Practice Address - Phone:480-299-0926
Practice Address - Fax:623-215-7546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility