Provider Demographics
NPI:1780983684
Name:ROSE TENDER CARE
Entity type:Organization
Organization Name:ROSE TENDER CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARQUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:I
Authorized Official - Credentials:MR
Authorized Official - Phone:313-246-7883
Mailing Address - Street 1:19486 SHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2821
Mailing Address - Country:US
Mailing Address - Phone:313-246-7883
Mailing Address - Fax:248-824-2899
Practice Address - Street 1:19486 SHERWOOD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-2821
Practice Address - Country:US
Practice Address - Phone:313-246-7883
Practice Address - Fax:248-842-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X, 251S00000X, 251C00000X, 251G00000X, 261QM0850X, 251J00000X
163W00000X
MIR200585066270347C00000X
MI2280551311ZA0620X, 305S00000X, 253Z00000X, 252Y00000X, 251K00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate Vehicle
No251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No305S00000XManaged Care OrganizationsPoint of Service
No253Z00000XAgenciesIn Home Supportive Care
No252Y00000XAgenciesEarly Intervention Provider Agency
No251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI228055Medicaid
MI2280551Medicaid