Provider Demographics
NPI:1407624638
Name:MCINTOSH, ROSE (CCHW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MATLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3273
Mailing Address - Country:US
Mailing Address - Phone:979-645-3374
Mailing Address - Fax:
Practice Address - Street 1:225 MATLAGE WAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3273
Practice Address - Country:US
Practice Address - Phone:979-645-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9918172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker