Provider Demographics
NPI:1356611461
Name:ROSE R AND D
Entity type:Organization
Organization Name:ROSE R AND D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-220-0335
Mailing Address - Street 1:28525 W 83RD ST
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018-9612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28525 W 83RD ST
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:KS
Practice Address - Zip Code:66018-9612
Practice Address - Country:US
Practice Address - Phone:913-220-0335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS00100072519Medicaid