Healthcare Provider Details

I. General information

NPI: 1073948220
Provider Name (Legal Business Name): ROSELAWN GARDENS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11999 KLINGER AVE NE
ALLIANCE OH
44601-1116
US

IV. Provider business mailing address

11999 KLINGER AVE NE
ALLIANCE OH
44601-1116
US

V. Phone/Fax

Practice location:
  • Phone: 330-823-0618
  • Fax:
Mailing address:
  • Phone: 330-823-0618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1549N
License Number StateOH

VIII. Authorized Official

Name: PAUL B BERGSTEN
Title or Position: OWNER CEO
Credential: LNHA
Phone: 937-825-6622