1609870971 NPI number — ROSELAWN GARDENS NURSING & REHABILITATION, INC.

Table of content: (NPI 1609870971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609870971 NPI number — ROSELAWN GARDENS NURSING & REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSELAWN GARDENS NURSING & REHABILITATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609870971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 PARK AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44902-1624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-529-7272
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11999 KLINGER AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44601-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-823-0618
Provider Business Practice Location Address Fax Number:
330-821-3004
Provider Enumeration Date:
06/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BUNNER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-827-0389

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1549N , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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