Provider Demographics
NPI:1679813000
Name:ROSE GARDEN AFCH, LLC
Entity type:Organization
Organization Name:ROSE GARDEN AFCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:THELAMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-684-8722
Mailing Address - Street 1:335 ABALONE RD NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2961
Mailing Address - Country:US
Mailing Address - Phone:321-684-8722
Mailing Address - Fax:
Practice Address - Street 1:335 ABALONE RD NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2961
Practice Address - Country:US
Practice Address - Phone:321-684-8722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906251320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities