Provider Demographics
NPI:1902348873
Name:ESSENTIAL ROSE, LLC
Entity Type:Organization
Organization Name:ESSENTIAL ROSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAYLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DE LA ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-A, MBA
Authorized Official - Phone:504-220-8480
Mailing Address - Street 1:701 LOYOLA AVENUE
Mailing Address - Street 2:UNIT 57464
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70157
Mailing Address - Country:US
Mailing Address - Phone:504-220-8480
Mailing Address - Fax:
Practice Address - Street 1:701 LOYOLA AVE
Practice Address - Street 2:UNIT 57464
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70157-5001
Practice Address - Country:US
Practice Address - Phone:504-220-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4860302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization