Provider Demographics
NPI:1871195677
Name:ROSE, JEFFERY SCOT
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SCOT
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 BURNS RD
Mailing Address - Street 2:
Mailing Address - City:FELICITY
Mailing Address - State:OH
Mailing Address - Zip Code:45120-9672
Mailing Address - Country:US
Mailing Address - Phone:513-227-2354
Mailing Address - Fax:
Practice Address - Street 1:2468 BURNS RD
Practice Address - Street 2:
Practice Address - City:FELICITY
Practice Address - State:OH
Practice Address - Zip Code:45120-9672
Practice Address - Country:US
Practice Address - Phone:513-227-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care