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NPI Code Detail

MEDICARE: ROSE HAVEN

MEDICARE: ROSE HAVEN
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
1314000000XSkilled Nursing Facility1004095OR

General Provider Information

NPI Number : 1245406156
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSE HAVEN
Provider Business Mailing Address
First Line : 740 NW HILL AVE
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-1672
Country : US
Telephone Number : 541-672-1631
Fax Number : 541-672-1563
Provider Business Practice Location Address
First Line : 740 NW HILL AVE
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-1672
Country : US
Telephone Number : 541-672-1631
Fax Number : 541-672-1563
Authorized Official
Title or Position : OTR
Name : MR. BRIAN FISCHER
Credential : B.S.
Telephone Number : 541-672-1631
Provider Enumeration Date : 05/01/2008
Last Update Date : 05/01/2008

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Directions to “ROSE HAVEN ” Practice Location

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