Provider Demographics
NPI:1306390562
Name:ROSE SENIOR CARE
Entity Type:Organization
Organization Name:ROSE SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOMEMAKER/COMPANIES
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-586-7532
Mailing Address - Street 1:5327 TIMUQUANA RD APT 197
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-8074
Mailing Address - Country:US
Mailing Address - Phone:904-586-7532
Mailing Address - Fax:
Practice Address - Street 1:5327 TIMUQUANA RD APT 197
Practice Address - Street 2:5327 TIMUQUANA ROAD APT 197
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8074
Practice Address - Country:US
Practice Address - Phone:904-586-7532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care