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NPI Code Detail

MEDICARE: ROSEWOOD CARE CENTER OF ST LOUIS COUNTY, INC

MEDICARE: ROSEWOOD CARE CENTER OF ST LOUIS COUNTY, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)1303580001IL
2314000000XSkilled Nursing Facility031124MO

General Provider Information

NPI Number : 1093710824
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSEWOOD CARE CENTER OF ST LOUIS COUNTY, INC
Provider Business Mailing Address
First Line : 11701 BORMAN DR
Second Line : STE 315
City : SAINT LOUIS
State : MO
Zip : 63146-4194
Country : US
Telephone Number : 314-994-9070
Fax Number :
Provider Business Practice Location Address
First Line : 11278 SCHUETZ RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4957
Country : US
Telephone Number : 314-991-4066
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : LARRY VANDER MATEN
Credential :
Telephone Number : 314-994-9070
Provider Enumeration Date : 06/17/2005
Last Update Date : 04/20/2008

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