Provider Demographics
NPI:1972096196
Name:ROSE OF SHARON OF CENTRAL FL INC
Entity Type:Organization
Organization Name:ROSE OF SHARON OF CENTRAL FL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRAZIER
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-255-4060
Mailing Address - Street 1:PO BOX 490854
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0854
Mailing Address - Country:US
Mailing Address - Phone:352-255-4060
Mailing Address - Fax:
Practice Address - Street 1:1326 W NORTH BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3997
Practice Address - Country:US
Practice Address - Phone:352-255-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty