Provider Demographics
NPI:1689822868
Name:ROSE'S HOME MEDICAL SPECIALTY'S
Entity type:Organization
Organization Name:ROSE'S HOME MEDICAL SPECIALTY'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLSZTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-207-3563
Mailing Address - Street 1:2762 KADLEC DR APT 6
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6625
Mailing Address - Country:US
Mailing Address - Phone:608-207-3563
Mailing Address - Fax:608-313-9436
Practice Address - Street 1:2762 KADLEC DR APT 6
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6625
Practice Address - Country:US
Practice Address - Phone:608-207-3563
Practice Address - Fax:608-313-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-31
Last Update Date:2008-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41757000Medicaid