Healthcare Provider Details

I. General information

NPI: 1891142006
Provider Name (Legal Business Name): ROSE GARDEN SUBACUTE & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 N RAYMOND AVE
PASADENA CA
91103-1733
US

IV. Provider business mailing address

1899 N RAYMOND AVE
PASADENA CA
91103-1733
US

V. Phone/Fax

Practice location:
  • Phone: 626-797-2120
  • Fax: 626-797-2536
Mailing address:
  • Phone: 626-797-2120
  • Fax: 626-797-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DOV E JACOBS
Title or Position: MANAGER
Credential:
Phone: 310-398-8101