Provider Demographics
NPI:1982163499
Name:ROSEBUD PERSONAL SERVICE AGENCY
Entity Type:Organization
Organization Name:ROSEBUD PERSONAL SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-989-1725
Mailing Address - Street 1:PO BOX 68758
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0758
Mailing Address - Country:US
Mailing Address - Phone:317-989-1725
Mailing Address - Fax:844-296-2291
Practice Address - Street 1:6301 OLD BARN CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-4045
Practice Address - Country:US
Practice Address - Phone:317-989-1725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care