Provider Demographics
NPI:1477306439
Name:ROSE OF LIFE LLC
Entity Type:Organization
Organization Name:ROSE OF LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAM
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:862-249-8353
Mailing Address - Street 1:20 BANTA PL STE 203
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5606
Mailing Address - Country:US
Mailing Address - Phone:862-249-8353
Mailing Address - Fax:
Practice Address - Street 1:20 BANTA PL STE 203
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5606
Practice Address - Country:US
Practice Address - Phone:862-249-8353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health