Provider Demographics
NPI:1952562589
Name:ROSE HEALTHCARE CENTER
Entity Type:Organization
Organization Name:ROSE HEALTHCARE CENTER
Other - Org Name:ROSE CHIROPRACTIC CENER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS DC
Authorized Official - Phone:407-298-9211
Mailing Address - Street 1:6638 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1231
Mailing Address - Country:US
Mailing Address - Phone:407-298-9211
Mailing Address - Fax:407-298-9227
Practice Address - Street 1:6638 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1231
Practice Address - Country:US
Practice Address - Phone:407-298-9211
Practice Address - Fax:407-298-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111NN1001X
FL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4072989211OtherBCBS #22472
FL24492Medicare PIN