Individual
ROSELYN SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6850 MANHATTAN BLVD STE 300-25, FORT WORTH, TX 76120-1227
(817) 627-4735
Mailing address
PO BOX 24506, FORT WORTH, TX 76124-1506
(817) 627-4735
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
02/22/2023
Last updated
02/22/2023
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