Provider Demographics
NPI:1992523344
Name:ROSEBERRY INTEGRATIVE CARE
Entity type:Organization
Organization Name:ROSEBERRY INTEGRATIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-345-6261
Mailing Address - Street 1:4210 VALLEY RIDGE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5184
Mailing Address - Country:US
Mailing Address - Phone:901-800-5701
Mailing Address - Fax:904-839-0310
Practice Address - Street 1:4210 VALLEY RIDGE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32081-5184
Practice Address - Country:US
Practice Address - Phone:901-800-5701
Practice Address - Fax:904-839-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty