Healthcare Provider Details

I. General information

NPI: 1609876192
Provider Name (Legal Business Name): ROSEWOOD NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 15TH ST
LAKE CHARLES LA
70601-7336
US

IV. Provider business mailing address

534 15TH ST
LAKE CHARLES LA
70601-7336
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-8338
  • Fax: 337-310-8268
Mailing address:
  • Phone: 337-439-8338
  • Fax: 337-310-8268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number422
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number422
License Number StateLA

VIII. Authorized Official

Name: JOSEPH C TUTERA
Title or Position: MANAGER
Credential:
Phone: 181-644-4090