Provider Demographics
NPI:1336428051
Name:LITTLE ROSES HOME INC.
Entity Type:Organization
Organization Name:LITTLE ROSES HOME INC.
Other - Org Name:LITTLE ROSES BOARD AND CARE HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR/CAREGIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:EARLENE
Authorized Official - Last Name:ELIZONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-836-4623
Mailing Address - Street 1:4917 REGINA CIR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-1523
Mailing Address - Country:US
Mailing Address - Phone:505-836-4623
Mailing Address - Fax:
Practice Address - Street 1:4917 REGINA CIR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1523
Practice Address - Country:US
Practice Address - Phone:505-836-4623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2139310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility