Provider Demographics
NPI:1104261213
Name:ROSE RESILIENCY CENTER
Entity type:Organization
Organization Name:ROSE RESILIENCY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:MBA
Authorized Official - Phone:866-343-5509
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-0329
Mailing Address - Country:US
Mailing Address - Phone:866-343-5509
Mailing Address - Fax:570-839-5392
Practice Address - Street 1:2557 ROUTE 940
Practice Address - Street 2:SUITE 102
Practice Address - City:POCONO SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18346
Practice Address - Country:US
Practice Address - Phone:866-343-5509
Practice Address - Fax:570-839-5392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SECOND HAVEN SERVICES FOR YOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037460L103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty