Provider Demographics
NPI:1831408798
Name:ROSE GARDEN HEALTHCARE GROUP LLC
Entity type:Organization
Organization Name:ROSE GARDEN HEALTHCARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEKSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-957-0623
Mailing Address - Street 1:3934 CEDAR CAY CIR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-8222
Mailing Address - Country:US
Mailing Address - Phone:813-957-0623
Mailing Address - Fax:
Practice Address - Street 1:3934 CEDAR CAY CIR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-8222
Practice Address - Country:US
Practice Address - Phone:813-957-0623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 11040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty