Organization Active NPI

SRCV-Rosa, LLC.

Doing business as Santa Rosa Care Center

  • Skilled Nursing Facility
  • Tucson, AZ
National Provider Identifier
1205848405
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
NCI2621 Issued in AZ
Legal business name
SRCV-ROSA, LLC.
Doing business as
Santa Rosa Care Center
Practice address
1650 N Santa Rosa Ave
Tucson, AZ 85712-4039
Phone
(520) 795-1610
Fax
(520) 319-8046
NPI assigned
Aug 13, 2006
Last updated
May 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

Name
Brian D. Balliet
Title
Administrator
Phone
(520) 795-1610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NCI2621 AZ Primary

Addresses

Primary practice location

1650 N Santa Rosa Ave
Tucson, AZ 85712-4039

Mailing address

1650 N Santa Rosa Ave
Tucson, AZ 85712-4039
Phone (520) 795-1610

Other identifiers 1

IdentifierTypeStateIssuer
792491MedicaidAZ

Other names 1

  • Santa Rosa Care Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1205848405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 N SANTA ROSA AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124039",
            "telephone_number": "520-795-1610",
            "fax_number": "520-319-8046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 N SANTA ROSA AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857124039",
            "telephone_number": "520-795-1610",
            "fax_number": "520-319-8046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRCV-ROSA, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "BALLIET",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "520-795-1610"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AZ",
            "license": "NCI2621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "792491",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Rosa Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; 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.