Provider Demographics
NPI:1821310152
Name:ROSE ARBOR RESIDENCE
Entity Type:Organization
Organization Name:ROSE ARBOR RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:REILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-380-8773
Mailing Address - Street 1:3440 S GILLENWATER DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-8516
Mailing Address - Country:US
Mailing Address - Phone:928-380-8773
Mailing Address - Fax:928-266-0607
Practice Address - Street 1:3440 S GILLENWATER DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8516
Practice Address - Country:US
Practice Address - Phone:928-380-8773
Practice Address - Fax:928-266-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH 6870310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility