Provider Demographics
NPI:1477305316
Name:AAA ROSE GARDEN HOME LLC
Entity Type:Organization
Organization Name:AAA ROSE GARDEN HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYENAUCHEYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-993-2428
Mailing Address - Street 1:14631 RICHMOND AVE APT 435
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1696
Mailing Address - Country:US
Mailing Address - Phone:832-993-2428
Mailing Address - Fax:
Practice Address - Street 1:14631 RICHMOND AVE APT 435
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1696
Practice Address - Country:US
Practice Address - Phone:832-993-2428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities