Provider Demographics
NPI:1992984793
Name:ROSEWATER, INC.
Entity type:Organization
Organization Name:ROSEWATER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-641-8300
Mailing Address - Street 1:1515 MAGNAVOX WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1533
Mailing Address - Country:US
Mailing Address - Phone:260-459-1551
Mailing Address - Fax:260-459-1451
Practice Address - Street 1:2358 PERIMETER PARK DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1332
Practice Address - Country:US
Practice Address - Phone:770-641-8300
Practice Address - Fax:770-645-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services