Provider Demographics
NPI:1811000722
Name:AMANA ROSE, LLC
Entity Type:Organization
Organization Name:AMANA ROSE, LLC
Other - Org Name:HERITAGE HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-686-4366
Mailing Address - Street 1:700 N TOWN EAST BLVD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4770
Mailing Address - Country:US
Mailing Address - Phone:972-686-4366
Mailing Address - Fax:972-686-4372
Practice Address - Street 1:700 N TOWN EAST BLVD
Practice Address - Street 2:SUITE 159
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4770
Practice Address - Country:US
Practice Address - Phone:972-686-4366
Practice Address - Fax:888-686-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM679113Medicare ID - Type UnspecifiedMEDICARE ID #