Provider Demographics
NPI:1477980548
Name:ROSA'S CARING HEART
Entity Type:Organization
Organization Name:ROSA'S CARING HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAFRENCHEE
Authorized Official - Middle Name:LILLIAN
Authorized Official - Last Name:MCCREARY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:850-973-1308
Mailing Address - Street 1:587 SW BUNKER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32340-1907
Mailing Address - Country:US
Mailing Address - Phone:850-973-1308
Mailing Address - Fax:
Practice Address - Street 1:587 SW BUNKER ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1907
Practice Address - Country:US
Practice Address - Phone:850-973-1308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
FLAL123713104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115719300Medicaid