Provider Demographics
NPI:1508332545
Name:ROTELLA ADULT DAY & ACTIVITY CENTERS, LLC
Entity Type:Organization
Organization Name:ROTELLA ADULT DAY & ACTIVITY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEIDUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-616-5225
Mailing Address - Street 1:7307 CRESCENT BRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-1686
Mailing Address - Country:US
Mailing Address - Phone:281-616-5225
Mailing Address - Fax:713-583-8455
Practice Address - Street 1:7911 PINE HEATH CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4300
Practice Address - Country:US
Practice Address - Phone:281-616-5225
Practice Address - Fax:713-583-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care