Provider Demographics
NPI:1972132389
Name:ROSE, JOY L
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:L
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:L
Other - Last Name:WALRAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7800 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-4512
Mailing Address - Country:US
Mailing Address - Phone:916-698-2924
Mailing Address - Fax:
Practice Address - Street 1:8201 EVERSLEY CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-6045
Practice Address - Country:US
Practice Address - Phone:916-698-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician