Provider Demographics
NPI:1205009495
Name:ROSEWOOD ADULT RESIDENTIAL FACILITIES,INC.
Entity Type:Organization
Organization Name:ROSEWOOD ADULT RESIDENTIAL FACILITIES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDNET
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BREEDLOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-849-1338
Mailing Address - Street 1:4332 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3844
Mailing Address - Country:US
Mailing Address - Phone:310-849-1338
Mailing Address - Fax:
Practice Address - Street 1:1710 E 4TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-1904
Practice Address - Country:US
Practice Address - Phone:310-849-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness