ROSE TARA HOLDINGS LLC NPI 1902822182

NPI Information

NPI: 1902822182
Provider Name: ROSE TARA HOLDINGS, LLC

Doing Business As: ROSE TARA PLANTATION, INC

Classification: Custodial Care Facility - 311ZA0620X
Entity Type: Organization

Specialization: Adult Care Home

CLIA Number: 34D2019494

Address:
125 PLANTATION DR
KING, NC
ZIP 27021
Phone: (336) 983-8929
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ROSE TARA HOLDINGS, LLC is an adult care home custodial care facility in King, NC. The provider is a custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. ROSE TARA HOLDINGS, LLC NPI is 1902822182. The provider is registered as an organization entity type.
The provider Is Doing Business As Rose Tara Plantation, Inc.

The provider's business location address is:

125 PLANTATION DR
KING, NC
ZIP 27021-590
Phone: (336) 983-8929
Fax: (336) 983-7424

The provider's authorized official is Charles E Trefzger .
The authorized official title is Manager and has the following contact phone number (828) 322-5535.

The CLIA number assigned to this NPI record is 34D2019494 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/14/2006 and was last updated on 10/11/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	343900000X	Non-emergency Medical Transport (VAN)				No
2	310400000X	Assisted Living Facility		HAL-085-008	NORTH CAROLINA	No
3	311ZA0620X	Custodial Care Facility	Adult Care Home			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7805465	MEDICAID	NORTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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