| Sa Rosebud Home Llc | |
|
234 Rosebud Ave Irvine KY 40336-1204 | |
| (561) 779-2123 | |
| Not Available |
| Full Name | Sa Rosebud Home Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 234 Rosebud Ave, Irvine, Kentucky |
| Authorized Official Name and Position | Najam Khan (CASE MANAGER) |
| Authorized Official Contact | 5617792123 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sa Rosebud Home Llc 1160 Brick House Ln Lexington KY 40509-8563 Ph: (561) 779-2123 | Sa Rosebud Home Llc 234 Rosebud Ave Irvine KY 40336-1204 Ph: (561) 779-2123 |
| NPI Number | 1609657568 |
|---|---|
| Provider Enumeration Date | 10/06/2023 |
| Last Update Date | 10/19/2023 |
| Certification Date | 10/19/2023 |
| Medicare PECOS PAC ID | 0648628602 |
|---|---|
| Medicare Enrollment ID | O20231130003674 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609657568 | NPI | - | NPPES |
| Provider Name | Diana Spring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003212515 PECOS PAC ID: 7618270216 Enrollment ID: I20160126002323 |
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