Provider Demographics
NPI:1629801451
Name:ROSEBOROUGH, MONICA NACOLE (OPERATOR OWNER)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:NACOLE
Last Name:ROSEBOROUGH
Suffix:
Gender:M
Credentials:OPERATOR OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 S MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3709
Mailing Address - Country:US
Mailing Address - Phone:316-806-1588
Mailing Address - Fax:316-352-7646
Practice Address - Street 1:4911 S MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3709
Practice Address - Country:US
Practice Address - Phone:316-806-1588
Practice Address - Fax:316-352-7646
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility