Provider Demographics
NPI:1235564881
Name:ROSEWOOD OF CARSON CITY
Entity Type:Organization
Organization Name:ROSEWOOD OF CARSON CITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LICENSEE DESIGNEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RUTHIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-875-2998
Mailing Address - Street 1:1306 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-9501
Mailing Address - Country:US
Mailing Address - Phone:989-875-2998
Mailing Address - Fax:989-875-2988
Practice Address - Street 1:8565 S MOUNT HOPE RD
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811-9723
Practice Address - Country:US
Practice Address - Phone:989-954-8988
Practice Address - Fax:989-584-6775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSEWOOD ADULT FOSTER CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS590315251311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4766706Medicaid