Provider Demographics
NPI:1629487178
Name:ROSA'S ASSISTED LIVING
Entity Type:Organization
Organization Name:ROSA'S ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:210-650-9963
Mailing Address - Street 1:7715 OAKHILL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4455
Mailing Address - Country:US
Mailing Address - Phone:210-382-8788
Mailing Address - Fax:
Practice Address - Street 1:5254 ROUND TABLE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-2826
Practice Address - Country:US
Practice Address - Phone:210-650-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX138374320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528594471Medicaid
TX508295273Medicaid
TX519497093Medicaid
TX516824935Medicaid
TX466305766C1Medicare PIN
TX463627930AMedicare PIN
TX226680226AMedicare PIN
TX516824935Medicaid
TX508295273Medicaid
TX519497093Medicaid