Provider Demographics
NPI:1447734934
Name:RECOVER OR SACRIFICE EVERYTHING (ROSE) COUNSELING CENTER
Entity Type:Organization
Organization Name:RECOVER OR SACRIFICE EVERYTHING (ROSE) COUNSELING CENTER
Other - Org Name:ROSE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR / PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MOCZYGEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:SAP, LCDC, MS
Authorized Official - Phone:512-653-8922
Mailing Address - Street 1:1825 FORTVIEW RD STE 106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7600
Mailing Address - Country:US
Mailing Address - Phone:512-653-8922
Mailing Address - Fax:
Practice Address - Street 1:1825 FORTVIEW RD STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7600
Practice Address - Country:US
Practice Address - Phone:512-653-8922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32067800204OtherTAX ID