Provider Demographics
NPI:1144769860
Name:ROSE Q. BASILE, LLC
Entity Type:Organization
Organization Name:ROSE Q. BASILE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCIO
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SLP
Authorized Official - Phone:561-386-3986
Mailing Address - Street 1:199 CYPRESS TRCE
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4960
Mailing Address - Country:US
Mailing Address - Phone:561-386-3986
Mailing Address - Fax:
Practice Address - Street 1:199 CYPRESS TRCE
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4960
Practice Address - Country:US
Practice Address - Phone:561-386-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA115070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty