Provider Demographics
NPI:1578624151
Name:SERA ROSE ASSISTED LIVING
Entity Type:Organization
Organization Name:SERA ROSE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:CAMACHO
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:806-293-4449
Mailing Address - Street 1:410 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7232
Mailing Address - Country:US
Mailing Address - Phone:806-293-4449
Mailing Address - Fax:
Practice Address - Street 1:410 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7232
Practice Address - Country:US
Practice Address - Phone:806-293-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117086310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility