Provider Demographics
NPI:1023739737
Name:ROSE'S PREMIER PERSONAL CARE HOME, CORPORATION
Entity type:Organization
Organization Name:ROSE'S PREMIER PERSONAL CARE HOME, CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-908-8502
Mailing Address - Street 1:3905 PRICE RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-5362
Mailing Address - Country:US
Mailing Address - Phone:678-696-5428
Mailing Address - Fax:
Practice Address - Street 1:3905 PRICE RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-5362
Practice Address - Country:US
Practice Address - Phone:678-696-5428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCH008016OtherSTATE PROVIDER ID