Provider Demographics
NPI:1902201189
Name:ROSE'S RETIREMENT HOME
Entity Type:Organization
Organization Name:ROSE'S RETIREMENT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-255-8158
Mailing Address - Street 1:11520 SW 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3967
Mailing Address - Country:US
Mailing Address - Phone:305-225-8158
Mailing Address - Fax:305-232-0976
Practice Address - Street 1:11520 SW 108TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3967
Practice Address - Country:US
Practice Address - Phone:305-225-8158
Practice Address - Fax:305-232-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-29
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 58310400000X, 3104A0625X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141091100Medicaid