Provider Demographics
NPI:1760924062
Name:ROSE GARDEN SENIOR CARE LLC
Entity Type:Organization
Organization Name:ROSE GARDEN SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDIE
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:CARGILE
Authorized Official - Suffix:
Authorized Official - Credentials:AA
Authorized Official - Phone:858-668-9715
Mailing Address - Street 1:2138 SAN VICENTE RD
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-3726
Mailing Address - Country:US
Mailing Address - Phone:858-668-9715
Mailing Address - Fax:
Practice Address - Street 1:2138 SAN VICENTE RD
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-3726
Practice Address - Country:US
Practice Address - Phone:858-668-9715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care