NPIMap

Organization Active NPI

Rose Resiliency Center

  • Prescribing (Medical) Psychologist
  • Pocono Summit, PA
National Provider Identifier
1104261213
Registry record updated May 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prescribing (Medical) PsychologistTaxonomy code 103TP0016X
License
MD037460L Issued in PA
Legal business name
ROSE RESILIENCY CENTER
Practice address
2557 Route 940
Suite 102
Pocono Summit, PA 18346
Phone
(866) 343-5509
Fax
(570) 839-5392
NPI assigned
May 2, 2013
Organization subpart
Yes
Parent organization
SECOND HAVEN SERVICES FOR YOUTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Freeman IV, MBA
Title
Executive Director
Phone
(866) 343-5509

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prescribing (Medical) PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TP0016X MD037460L PA Primary

Addresses

Primary practice location

2557 Route 940
Suite 102
Pocono Summit, PA 18346

Mailing address

PO Box 329
Mount Pocono, PA 18344-0329
Phone (866) 343-5509

National Provider Directory

National Provider Directory
Tax ID family
Second Haven Services for Youth Inc2 organizations share this tax ID, including this one
Part of
Second Haven Services for Youth Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2557 Route 940
Ste 102
Pocono Summit, PA 18346
Phone (570) 992-9143

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367452800000",
    "number": "1104261213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 329",
            "city": "MOUNT POCONO",
            "state": "PA",
            "postal_code": "183440329",
            "telephone_number": "866-343-5509",
            "fax_number": "570-839-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2557 ROUTE 940",
            "address_2": "SUITE 102",
            "city": "POCONO SUMMIT",
            "state": "PA",
            "postal_code": "18346",
            "telephone_number": "866-343-5509",
            "fax_number": "570-839-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE RESILIENCY CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SECOND HAVEN SERVICES FOR YOUTH",
        "enumeration_date": "2013-05-02",
        "last_updated": "2013-05-02",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "866-343-5509",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "103TP0016X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "PA",
            "license": "MD037460L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocono Summit, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.