Basic Information
| Provider Information | |||||||||
| NPI: | 1427564335 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSEWOOD RANCH, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WINDY RIDGE PKWY SE STE 210 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303395665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4704401647 | ||||||||
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| Practice Location | |||||||||
| Address1: | 36075 S RINCON RD | ||||||||
| Address2: | |||||||||
| City: | WICKENBURG | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853902491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286849594 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2017 | ||||||||
| LastUpdateDate: | 12/15/2017 | ||||||||
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| AuthorizedOfficialLastName: | TOWNSEND | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4704401647 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RIVERMEND HEALTH, LLC | ||||||||
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| AuthorizedOfficialCredential: | MPH, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | BH-1594 | AZ | N | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | 283Q00000X | BH-1594 | AZ | Y | Hospitals | Psychiatric Hospital |
No ID Information.