Provider Demographics
NPI:1285815910
Name:ROSEWOOD ASSISTED LIVING
Entity Type:Organization
Organization Name:ROSEWOOD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAVERI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-580-6280
Mailing Address - Street 1:101 DAVELIN PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-4507
Mailing Address - Country:US
Mailing Address - Phone:919-580-9733
Mailing Address - Fax:919-580-9733
Practice Address - Street 1:100 PERKINS ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9335
Practice Address - Country:US
Practice Address - Phone:919-735-8998
Practice Address - Fax:919-735-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL096034310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility