Provider Demographics
NPI:1154461259
Name:ROSEWOOD ASSISTED LIVING
Entity Type:Organization
Organization Name:ROSEWOOD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR LTC ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-206-8003
Mailing Address - Street 1:1587 OLD FREEHOLD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2173
Mailing Address - Country:US
Mailing Address - Phone:732-240-0043
Mailing Address - Fax:
Practice Address - Street 1:1587 OLD FREEHOLD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-2173
Practice Address - Country:US
Practice Address - Phone:732-240-0043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ65A112310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0062553Medicaid