MEDICARE: ROSE HAVEN HEALTHCARE 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	314000000X	Skilled Nursing Facility	129334	TX

General Provider Information

NPI Number	:	1811269533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE HAVEN HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	410 MONMOUTH AVE
Second Line	:	SUITE 130
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 LIVE OAK ST
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551-2802
Country	:	US
Telephone Number	:	903-796-4127
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MENACHEM M SHAPIRO
Credential	:
Telephone Number	:	732-961-9000

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	12/01/2016

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