Active NPI
Roselyn Small
- Adult Care Home Facility
- Fort Worth, TX
National Provider Identifier
1902504459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- Practice address
- 6850 Manhattan Blvd Ste 300-25
Fort Worth, TX 76120-1227 - Phone
- (817) 627-4735
- NPI assigned
- Feb 22, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | |||
| Contractor | 171W00000X | |||
| In Home Supportive Care Agency | 253Z00000X | |||
| Assisted Living Facility | 310400000X | |||
| Homemaker | 376J00000X | |||
| Adult Care Home Facility | 311ZA0620X | Primary |
Addresses
Primary practice location
6850 Manhattan Blvd Ste 300-25
Fort Worth, TX 76120-1227
Mailing address
PO Box 24506
Fort Worth, TX 76124-1506
Phone (817) 627-4735
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677024000000",
"number": "1902504459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 24506",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761241506",
"telephone_number": "817-627-4735"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6850 MANHATTAN BLVD STE 300-25",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761201227",
"telephone_number": "817-627-4735"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMALL",
"first_name": "ROSELYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-22",
"last_updated": "2023-02-22",
"certification_date": "2023-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": null,
"license": null,
"primary": false
},
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": null,
"license": null,
"primary": false
},
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.