Provider Demographics
NPI:1073948220
Name:ROSELAWN GARDENS HEALTHCARE
Entity Type:Organization
Organization Name:ROSELAWN GARDENS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:BERGSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-825-6622
Mailing Address - Street 1:11999 KLINGER AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-1116
Mailing Address - Country:US
Mailing Address - Phone:330-823-0618
Mailing Address - Fax:
Practice Address - Street 1:11999 KLINGER AVE NE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-1116
Practice Address - Country:US
Practice Address - Phone:330-823-0618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1549N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility