Provider Demographics
NPI:1144117433
Name:BLU ROSES GARDEN LLC
Entity type:Organization
Organization Name:BLU ROSES GARDEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMIKA
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:POMPEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW,CA
Authorized Official - Phone:336-791-6556
Mailing Address - Street 1:1116 JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-5324
Mailing Address - Country:US
Mailing Address - Phone:336-791-6556
Mailing Address - Fax:
Practice Address - Street 1:1116 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-5324
Practice Address - Country:US
Practice Address - Phone:336-791-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-20
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health