1205009495 NPI number — ROSEWOOD ADULT RESIDENTIAL FACILITIES,INC.

Table of content: REBECCA BELLE HOLMAN LMSW (NPI 1417409079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205009495 NPI number — ROSEWOOD ADULT RESIDENTIAL FACILITIES,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSEWOOD ADULT RESIDENTIAL FACILITIES,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205009495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4332 PARKVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90712-3844
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-849-1338
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 E 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90802-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-849-1338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BREEDLOVE
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
VICE PRESIDNET
Authorized Official Telephone Number:
310-849-1338

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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