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NPI Code Detail

MEDICARE: ROSEWOOD CARE CENTER, INC OF ELGIN

MEDICARE: ROSEWOOD CARE CENTER, INC OF ELGIN
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)1303600001IL
2314000000XSkilled Nursing Facility0040006IL

General Provider Information

NPI Number : 1356346290
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROSEWOOD CARE CENTER, INC OF ELGIN
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 : 2355 ROYAL BLVD
Second Line :
City : ELGIN
State : IL
Zip : 60123-4716
Country : US
Telephone Number : 847-888-9585
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : LARRY VANDER MATEN
Credential :
Telephone Number : 314-994-9070
Provider Enumeration Date : 06/16/2005
Last Update Date : 04/20/2008

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Directions to “ROSEWOOD CARE CENTER, INC OF ELGIN ” Practice Location

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