Provider Demographics
NPI:1841379989
Name:SANTA ROSA ELDERLY CENTER
Entity Type:Organization
Organization Name:SANTA ROSA ELDERLY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE UNIT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITETHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-383-7251
Mailing Address - Street 1:7900 S J STOCK RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-7012
Mailing Address - Country:US
Mailing Address - Phone:520-295-2503
Mailing Address - Fax:520-295-2676
Practice Address - Street 1:JUNCTION OF BIA 15 AND BIA 34
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-295-2503
Practice Address - Fax:520-295-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare