MEDICARE: ROSEBUSH GARDENS ASSSISTED LIVING

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	S0067	IA

General Provider Information

NPI Number	:	1548349194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSEBUSH GARDENS ASSSISTED LIVING

Provider Business Mailing Address
First Line	:	4925 WEST AVE
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-9469
Country	:	US
Telephone Number	:	319-752-1200
Fax Number	:	319-752-5800

Provider Business Practice Location Address
First Line	:	4925 WEST AVE
Second Line	:
City	:	BURLINGTON
State	:	IA
Zip	:	52601-9469
Country	:	US
Telephone Number	:	319-752-1200
Fax Number	:	319-752-5800

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. KIRK WILLIAM ERICKSON
Credential	:
Telephone Number	:	319-752-1200

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/22/2020

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