Provider Demographics
NPI:1770669327
Name:ROSE-LUANN HOMES, INC.
Entity type:Organization
Organization Name:ROSE-LUANN HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ULIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-496-9990
Mailing Address - Street 1:17231 REGULUS DR.
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886
Mailing Address - Country:US
Mailing Address - Phone:714-528-6187
Mailing Address - Fax:714-996-9211
Practice Address - Street 1:17231 REGULUS DR.
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-528-6187
Practice Address - Fax:714-996-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320600000X
CA060000806313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55G-439OtherCAL OPTIMA
CALTC80330FOtherMEDICAID LTC