Provider Demographics
NPI:1740159706
Name:TUDOR ROSE EMPIRE LLC
Entity type:Organization
Organization Name:TUDOR ROSE EMPIRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:945-337-4015
Mailing Address - Street 1:2801 LIVE OAK ST APT 1311
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5716
Mailing Address - Country:US
Mailing Address - Phone:945-337-4015
Mailing Address - Fax:
Practice Address - Street 1:2801 LIVE OAK ST APT 1311
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5716
Practice Address - Country:US
Practice Address - Phone:945-337-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health