Provider Demographics
NPI:1346549201
Name:ROSE AUBOURG SERVICES LLC
Entity Type:Organization
Organization Name:ROSE AUBOURG SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NSUDILA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:AUBOURG
Authorized Official - Suffix:
Authorized Official - Credentials:ASSOCIATE DEGREE
Authorized Official - Phone:857-544-9100
Mailing Address - Street 1:169 WOOD AVE
Mailing Address - Street 2:SUITE1
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3823
Mailing Address - Country:US
Mailing Address - Phone:857-544-9100
Mailing Address - Fax:617-361-6981
Practice Address - Street 1:169 WOOD AVE
Practice Address - Street 2:SUITE1
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3823
Practice Address - Country:US
Practice Address - Phone:857-544-9100
Practice Address - Fax:617-361-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8020253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8020OtherLICENCE FROM DIVISION OF OCCUPATIONAL SAFETY