Provider Demographics
NPI:1649869314
Name:ROISE AT HEART HOMECARE LLC
Entity type:Organization
Organization Name:ROISE AT HEART HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TICHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-560-6990
Mailing Address - Street 1:338 W TATE ST STE D
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-2624
Mailing Address - Country:US
Mailing Address - Phone:662-560-6990
Mailing Address - Fax:
Practice Address - Street 1:338 W TATE ST STE D
Practice Address - Street 2:
Practice Address - City:SENATOBIA
Practice Address - State:MS
Practice Address - Zip Code:38668-2624
Practice Address - Country:US
Practice Address - Phone:662-560-6990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health