MEDICARE: ROSEWOOD CARE CENTER, INC OF ROCKFORD

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
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	1303560001	IL
2	314000000X	Skilled Nursing Facility	0041756	IL

General Provider Information

NPI Number	:	1306841135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEWOOD CARE CENTER, INC OF ROCKFORD

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	:	1660 S MULFORD RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-6760
Country	:	US
Telephone Number	:	815-397-8700
Fax Number	:

Authorized Official
Title or Position	:	CONTROLLER
Name	:	CHUCK SCHMITZ
Credential	:
Telephone Number	:	314-994-9070

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/20/2008

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