Provider Demographics
NPI:1689918591
Name:ROSETTA'S KEY
Entity Type:Organization
Organization Name:ROSETTA'S KEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ROSETTA
Authorized Official - Last Name:JORDAN SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-602-8793
Mailing Address - Street 1:8930 FOURWINDS DR
Mailing Address - Street 2:SUITE 337
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1970
Mailing Address - Country:US
Mailing Address - Phone:210-410-1595
Mailing Address - Fax:210-590-0355
Practice Address - Street 1:8930 FOURWINDS DR
Practice Address - Street 2:SUITE 337
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-1970
Practice Address - Country:US
Practice Address - Phone:210-410-1595
Practice Address - Fax:210-590-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61621251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2826976Medicaid