MEDICARE: ROSEWOOD OF CARSON CITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility	AS590315251	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235564881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEWOOD OF CARSON CITY

Provider Business Mailing Address
First Line	:	1306 S STATE RD
Second Line	:
City	:	ITHACA
State	:	MI
Zip	:	48847-9501
Country	:	US
Telephone Number	:	989-875-2998
Fax Number	:	989-875-2988

Provider Business Practice Location Address
First Line	:	8565 S MOUNT HOPE RD
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-9723
Country	:	US
Telephone Number	:	989-954-8988
Fax Number	:	989-584-6775

Authorized Official
Title or Position	:	OWNER / LICENSEE DESIGNEE
Name	:	MRS. MYRA SUE RUTHIG
Credential	:
Telephone Number	:	989-875-2998

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	09/13/2013

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Directions to “ROSEWOOD OF CARSON CITY ” Practice Location

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