Provider Demographics
NPI:1972585180
Name:ROSEDOVE INC
Entity type:Organization
Organization Name:ROSEDOVE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT CARE SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMRETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:800-919-6419
Mailing Address - Street 1:1420 N CLAREMONT BLVD STE 104A
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3583
Mailing Address - Country:US
Mailing Address - Phone:909-624-0100
Mailing Address - Fax:909-624-0606
Practice Address - Street 1:1420 N CLAREMONT BLVD STE 104A
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3583
Practice Address - Country:US
Practice Address - Phone:909-624-0100
Practice Address - Fax:909-624-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC01765FOtherMEDI-CAL PROVIDER ID#
CA051765Medicare ID - Type UnspecifiedPROVIDER ID#