Provider Demographics
NPI:1619331121
Name:THE ROSE ASSISTED LIVING CENTER
Entity Type:Organization
Organization Name:THE ROSE ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-241-1141
Mailing Address - Street 1:10814 TWIN CIRCLES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4734
Mailing Address - Country:US
Mailing Address - Phone:713-241-1141
Mailing Address - Fax:713-241-1149
Practice Address - Street 1:10814 TWIN CIRCLES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-4734
Practice Address - Country:US
Practice Address - Phone:713-241-1141
Practice Address - Fax:713-241-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010069251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467607689Medicaid
TX1467607689Medicare NSC