Rose, Jennifer Beth
Rose, Jennifer Beth is an sole proprietor health care provider with primary practice located at 2111 Golf Course Rd Se Ste D , Rio Rancho NM 87124-1634. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Rose, Jennifer Beth can be contacted via phone (505) 639-1312.Contact Information
Primary practice address
2111 Golf Course Rd Se Ste D
Rio Rancho NM 87124-1634
Phone: (505) 639-1312
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | C-06999 | New Mexico |
Profile Details
| NPI number | 1104864255 |
|---|---|
| LBN Legal business name | Rose, Jennifer Beth |
| Credentials | LISW |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 2nd, 2006 |
| Last updated | Feb 12th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104864255 | NPPES |
| New Mexico | MEDICAID | 02351714 | |
| New Mexico | Other | 1598218190 | |
| New Mexico | Other | 1104864255 | |
| New Mexico | MEDICAID | 17301866 |
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