MEDICARE: ROSEWOOD ASSISTED LIVING, LLC

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	310400000X	Assisted Living Facility	CRC1367	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518307446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEWOOD ASSISTED LIVING, LLC

Provider Business Mailing Address
First Line	:	5221 HIGHWAY 215
Second Line	:
City	:	PAULINE
State	:	SC
Zip	:	29374
Country	:	US
Telephone Number	:	864-573-4060
Fax Number	:	864-573-1050

Provider Business Practice Location Address
First Line	:	5221 HIGHWAY 215
Second Line	:
City	:	PAULINE
State	:	SC
Zip	:	29374
Country	:	US
Telephone Number	:	864-573-4060
Fax Number	:	864-573-1050

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MS. KIMBERLY HOWELL CLOBES
Credential	:	M.L.A., CRCFA
Telephone Number	:	864-573-4060

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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