Provider Demographics
NPI:1740083229
Name:ROSE, ASIM JR
Entity type:Individual
Prefix:
First Name:ASIM
Middle Name:
Last Name:ROSE
Suffix:JR
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11814 OAKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-1869
Mailing Address - Country:US
Mailing Address - Phone:216-906-1967
Mailing Address - Fax:
Practice Address - Street 1:11814 OAKFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-1869
Practice Address - Country:US
Practice Address - Phone:216-906-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp