Provider Demographics
NPI:1255474714
Name:ROCHESTER RESIDENTIAL CARE
Entity Type:Organization
Organization Name:ROCHESTER RESIDENTIAL CARE
Other - Org Name:JEAN BEASON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEASON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:940-742-3437
Mailing Address - Street 1:705 CAROTHERS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:TX
Mailing Address - Zip Code:79544-2003
Mailing Address - Country:US
Mailing Address - Phone:940-742-3437
Mailing Address - Fax:940-742-7702
Practice Address - Street 1:705 CAROTHERS AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:TX
Practice Address - Zip Code:79544-2003
Practice Address - Country:US
Practice Address - Phone:940-742-3437
Practice Address - Fax:940-742-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10855164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119189OtherASSITED LIVING TYPE C