Provider Demographics
NPI:1346056215
Name:ROSE GARDEN PSYCHIATRIC NURSING SERVICES
Entity type:Organization
Organization Name:ROSE GARDEN PSYCHIATRIC NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KILFORD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:707-690-0814
Mailing Address - Street 1:201 COGGINS DR APT B305
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4573
Mailing Address - Country:US
Mailing Address - Phone:707-690-0814
Mailing Address - Fax:
Practice Address - Street 1:4000 CAMINO TASSAJARA
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4711
Practice Address - Country:US
Practice Address - Phone:707-690-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty