Provider Demographics
NPI:1265621700
Name:FOUR ROSES LLC
Entity type:Organization
Organization Name:FOUR ROSES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIBEN
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:636-916-0022
Mailing Address - Street 1:926 HEMSATH RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6728
Mailing Address - Country:US
Mailing Address - Phone:636-916-0022
Mailing Address - Fax:636-916-0023
Practice Address - Street 1:926 HEMSATH RD STE 104A
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6728
Practice Address - Country:US
Practice Address - Phone:636-916-0022
Practice Address - Fax:636-916-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267612Medicare Oscar/Certification