Healthcare Provider Details

I. General information

NPI: 1154320463
Provider Name (Legal Business Name): ROSEVILLE CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 CIRBY WAY
ROSEVILLE CA
95661-4421
US

IV. Provider business mailing address

4020 SIERRA COLLEGE BLVD SUITE 190
ROCKLIN CA
95677-3906
US

V. Phone/Fax

Practice location:
  • Phone: 916-782-1238
  • Fax: 916-782-1238
Mailing address:
  • Phone: 916-624-6230
  • Fax: 916-624-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030000002
License Number StateCA

VIII. Authorized Official

Name: LARRY E BEAR
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 916-624-6230