Individual
LAURA LARAINE ROSARIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1095 POPLAR ST, NELSONVILLE, OH 45764-1446
(740) 221-0348
Mailing address
24 HOME ST APT 504, ATHENS, OH 45701-2070
(740) 221-0348
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
0221456
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0221456
—
OH
Enumeration date
10/04/2020
Last updated
10/04/2020
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