Provider Demographics
NPI:1982038402
Name:ROSE GARDEN
Entity Type:Organization
Organization Name:ROSE GARDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BAHAVIORAL ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:ELLEEN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-517-0817
Mailing Address - Street 1:1109 EMERYWOOD CT APT D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-9041
Mailing Address - Country:US
Mailing Address - Phone:702-517-0817
Mailing Address - Fax:
Practice Address - Street 1:1109 EMERYWOOD CT
Practice Address - Street 2:UNIT D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9041
Practice Address - Country:US
Practice Address - Phone:702-517-0817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health