Provider Demographics
NPI:1790372605
Name:CRDEN ROSE HOLDING COMPANY
Entity type:Organization
Organization Name:CRDEN ROSE HOLDING COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LA TOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-231-7551
Mailing Address - Street 1:3118 ROBERTA RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-9080
Mailing Address - Country:US
Mailing Address - Phone:704-965-1054
Mailing Address - Fax:352-554-5073
Practice Address - Street 1:3118 ROBERTA RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-9080
Practice Address - Country:US
Practice Address - Phone:704-965-1054
Practice Address - Fax:352-554-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No291U00000XLaboratoriesClinical Medical Laboratory