Provider Demographics
NPI:1053790287
Name:THE STABLES AT ROSE OF SHARON
Entity type:Organization
Organization Name:THE STABLES AT ROSE OF SHARON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:DEENA
Authorized Official - Last Name:PELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:330-697-4382
Mailing Address - Street 1:1021 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9711
Mailing Address - Country:US
Mailing Address - Phone:330-697-4382
Mailing Address - Fax:
Practice Address - Street 1:1021 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9711
Practice Address - Country:US
Practice Address - Phone:330-697-4382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation