Provider Demographics
NPI:1245406156
Name:ROSE HAVEN
Entity Type:Organization
Organization Name:ROSE HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:541-672-1631
Mailing Address - Street 1:740 NW HILL AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-1672
Mailing Address - Country:US
Mailing Address - Phone:541-672-1631
Mailing Address - Fax:541-672-1563
Practice Address - Street 1:740 NW HILL AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1672
Practice Address - Country:US
Practice Address - Phone:541-672-1631
Practice Address - Fax:541-672-1563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINNACLE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1004095314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility