Provider Demographics
NPI:1346008729
Name:ROSIE PERSONAL CARE SERVICE
Entity Type:Organization
Organization Name:ROSIE PERSONAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-322-8425
Mailing Address - Street 1:2626 ALPINE FIR LN APT 5D
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-8770
Mailing Address - Country:US
Mailing Address - Phone:574-322-8425
Mailing Address - Fax:
Practice Address - Street 1:2626 ALPINE FIR LN APT 5D
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-8770
Practice Address - Country:US
Practice Address - Phone:574-322-8425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care