Provider Demographics
NPI:1245707595
Name:WHITE ROSE GROUP, LLC
Entity type:Organization
Organization Name:WHITE ROSE GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SHORES BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-354-7887
Mailing Address - Street 1:901 N PATRICIA G CT
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1811
Mailing Address - Country:US
Mailing Address - Phone:602-354-7887
Mailing Address - Fax:602-354-5802
Practice Address - Street 1:4131 N 24TH ST STE A116
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6262
Practice Address - Country:US
Practice Address - Phone:602-796-9379
Practice Address - Fax:602-354-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based