Provider Demographics
NPI:1194542159
Name:ROSE, SHALIMAR
Entity type:Individual
Prefix:
First Name:SHALIMAR
Middle Name:
Last Name:ROSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 E FRANKLIN BLVD
Mailing Address - Street 2:STE 100 #275
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4983
Mailing Address - Country:US
Mailing Address - Phone:704-685-8051
Mailing Address - Fax:
Practice Address - Street 1:1616 NEAL HAWKINS RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-6429
Practice Address - Country:US
Practice Address - Phone:704-685-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health