Provider Demographics
NPI:1962499566
Name:CAMILIA ROSE COMPANY INC
Entity Type:Organization
Organization Name:CAMILIA ROSE COMPANY INC
Other - Org Name:CAMILIA ROSE CARE CENTER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TJOSVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-567-8951
Mailing Address - Street 1:11800 XEON BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-2061
Mailing Address - Country:US
Mailing Address - Phone:763-755-8400
Mailing Address - Fax:783-755-8578
Practice Address - Street 1:11800 XEON BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-2061
Practice Address - Country:US
Practice Address - Phone:763-755-8400
Practice Address - Fax:783-755-8578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMILIA ROSE COMPANY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN326976314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231243300Medicaid
MN231243300Medicaid