Provider Demographics
NPI:1336672856
Name:ROSIALYLLC DBA GARLAND ADULT CARE CENTER
Entity Type:Organization
Organization Name:ROSIALYLLC DBA GARLAND ADULT CARE CENTER
Other - Org Name:NO
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-834-7989
Mailing Address - Street 1:3845 N. GARLAND AVE
Mailing Address - Street 2:SUITE 700B
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040
Mailing Address - Country:US
Mailing Address - Phone:469-298-0205
Mailing Address - Fax:
Practice Address - Street 1:3845 N. GARLAND AVE
Practice Address - Street 2:700B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:469-233-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147020OtherLICENSE NUMBER