Provider Demographics
NPI:1578932489
Name:ROSE ASSISTED LIVING FACILITY, LLC.
Entity Type:Organization
Organization Name:ROSE ASSISTED LIVING FACILITY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANSISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEREZIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-207-7622
Mailing Address - Street 1:256 SW MOSELLE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5028
Mailing Address - Country:US
Mailing Address - Phone:718-838-4313
Mailing Address - Fax:772-237-2234
Practice Address - Street 1:256 SW MOSELLE AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5028
Practice Address - Country:US
Practice Address - Phone:718-838-4313
Practice Address - Fax:772-237-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12659385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care