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NPI Code Detail

MEDICARE: ROSEWOOD CARE CENTER, INC OF NORTHBROOK

MEDICARE: ROSEWOOD CARE CENTER, INC OF NORTHBROOK
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)1303570001IL
2314000000XSkilled Nursing Facility0042341IL

General Provider Information

NPI Number : 1184629909
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSEWOOD CARE CENTER, INC OF NORTHBROOK
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 : 4101 LAKE COOK RD
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-1112
Country : US
Telephone Number : 847-562-1770
Fax Number :
Authorized Official
Title or Position : SECRETARY
Name : MICHAEL BRADY
Credential :
Telephone Number : 314-994-9070
Provider Enumeration Date : 06/17/2005
Last Update Date : 04/20/2008

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