Provider Demographics
NPI:1588994503
Name:BAKER, ROSE MARY
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:MARY
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755
Mailing Address - Country:US
Mailing Address - Phone:727-515-3766
Mailing Address - Fax:727-412-8438
Practice Address - Street 1:1305 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755
Practice Address - Country:US
Practice Address - Phone:727-515-3766
Practice Address - Fax:727-412-8438
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906324311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home