Provider Demographics
NPI:1790419588
Name:ROSE LEGACY INSTITUTE, LLC
Entity Type:Organization
Organization Name:ROSE LEGACY INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEMIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-342-1939
Mailing Address - Street 1:735A SILVERBERRY CIR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87116-3108
Mailing Address - Country:US
Mailing Address - Phone:505-585-4276
Mailing Address - Fax:
Practice Address - Street 1:735A SILVERBERRY CIR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87116-3108
Practice Address - Country:US
Practice Address - Phone:505-585-4276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty