Provider Demographics
NPI:1013331958
Name:AMIE ROSE ASSISTED LIVING HOME, LLC
Entity Type:Organization
Organization Name:AMIE ROSE ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TED
Authorized Official - Middle Name:DIAZ
Authorized Official - Last Name:GADIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-241-9203
Mailing Address - Street 1:PO BOX 64248
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-4248
Mailing Address - Country:US
Mailing Address - Phone:520-241-9203
Mailing Address - Fax:520-829-3424
Practice Address - Street 1:2010 W GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1108
Practice Address - Country:US
Practice Address - Phone:520-241-9203
Practice Address - Fax:520-829-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9091H251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health