Provider Demographics
NPI:1386643948
Name:ROSE LANE, INC
Entity Type:Organization
Organization Name:ROSE LANE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NHA/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-833-3174
Mailing Address - Street 1:5425 HIGH MILL AVE NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9005
Mailing Address - Country:US
Mailing Address - Phone:330-833-3174
Mailing Address - Fax:330-833-4216
Practice Address - Street 1:5425 HIGH MILL AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-9005
Practice Address - Country:US
Practice Address - Phone:330-833-3174
Practice Address - Fax:330-833-4216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4070314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7500172Medicaid
OH7500172Medicaid