Provider Demographics
NPI:1902263080
Name:ROSEMORE GARNER JR
Entity Type:Organization
Organization Name:ROSEMORE GARNER JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHS
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSEMORE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:225-315-9905
Mailing Address - Street 1:6201 SUMMERLIN DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2672
Mailing Address - Country:US
Mailing Address - Phone:225-315-9905
Mailing Address - Fax:
Practice Address - Street 1:6201 SUMMERLIN DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2672
Practice Address - Country:US
Practice Address - Phone:225-315-9905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1159204Medicaid