Provider Demographics
NPI:1568275055
Name:OLD ROSWELL HOLDINGS LLC
Entity type:Organization
Organization Name:OLD ROSWELL HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-459-8005
Mailing Address - Street 1:5064 ROSWELL RD STE A200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2252
Mailing Address - Country:US
Mailing Address - Phone:410-459-8000
Mailing Address - Fax:404-256-5517
Practice Address - Street 1:1101 PARKWAY VIEW DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-1425
Practice Address - Country:US
Practice Address - Phone:412-697-4882
Practice Address - Fax:412-697-4898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies