Provider Demographics
NPI:1720299126
Name:WATERSIDE CASE MANAGEMENT
Entity Type:Organization
Organization Name:WATERSIDE CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-488-2544
Mailing Address - Street 1:1225 W 10TH ST
Mailing Address - Street 2:APT 7
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2557
Mailing Address - Country:US
Mailing Address - Phone:210-488-2544
Mailing Address - Fax:
Practice Address - Street 1:1225 W 10TH ST
Practice Address - Street 2:APT 7
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2557
Practice Address - Country:US
Practice Address - Phone:210-488-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management