Provider Demographics
NPI:1174651905
Name:BROUSSARD, ROSE SPRINGER (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:SPRINGER
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 SPRING ST.
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501
Mailing Address - Country:US
Mailing Address - Phone:707-441-9205
Mailing Address - Fax:
Practice Address - Street 1:720 WOOD ST
Practice Address - Street 2:CCT
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4413
Practice Address - Country:US
Practice Address - Phone:707-267-4246
Practice Address - Fax:707-476-4071
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator