Healthcare Provider Details

I. General information

NPI: 1255332862
Provider Name (Legal Business Name): ROSEWOOD MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 4TH ST
YORKVILLE OH
43971-1212
US

IV. Provider business mailing address

PO BOX 6230
WHEELING WV
26003-0722
US

V. Phone/Fax

Practice location:
  • Phone: 740-859-6496
  • Fax: 740-859-7120
Mailing address:
  • Phone: 304-242-7106
  • Fax: 304-242-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARY DAVIS
Title or Position: OWNER
Credential:
Phone: 740-859-6496