Provider Demographics
NPI:1568801678
Name:ROSELAND DEVELOPMENTAL HOMES, LLC
Entity Type:Organization
Organization Name:ROSELAND DEVELOPMENTAL HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:RYDEL
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-490-1228
Mailing Address - Street 1:1341 HOKE ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-2147
Mailing Address - Country:US
Mailing Address - Phone:256-439-2992
Mailing Address - Fax:256-439-2992
Practice Address - Street 1:404 JACKSONVILLE STREET
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901
Practice Address - Country:US
Practice Address - Phone:256-439-2992
Practice Address - Fax:256-439-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health