Provider Demographics
NPI:1972132389
Name:ROSE, JOY L
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:L
Last Name:ROSE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:L
Other - Last Name:WALRAVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4805 GOLDEN FOOTHILL PKWY
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9651
Mailing Address - Country:US
Mailing Address - Phone:916-698-2924
Mailing Address - Fax:
Practice Address - Street 1:4805 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9651
Practice Address - Country:US
Practice Address - Phone:916-698-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker