Provider Demographics
NPI:1700541216
Name:ROSE OF SHARON AT HOME, HOME CARE LLC
Entity Type:Organization
Organization Name:ROSE OF SHARON AT HOME, HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-688-1164
Mailing Address - Street 1:5024 DORSEY HALL DR STE 202D
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7869
Mailing Address - Country:US
Mailing Address - Phone:240-688-1164
Mailing Address - Fax:301-798-9876
Practice Address - Street 1:5024 DORSEY HALL DR STE 202D
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7869
Practice Address - Country:US
Practice Address - Phone:240-688-1164
Practice Address - Fax:301-798-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care