Provider Demographics
NPI:1417371121
Name:ROSEWOOD HOUSE II
Entity Type:Organization
Organization Name:ROSEWOOD HOUSE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-415-7600
Mailing Address - Street 1:3175 BELCHER RD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-9400
Mailing Address - Country:US
Mailing Address - Phone:727-781-2210
Mailing Address - Fax:727-781-2994
Practice Address - Street 1:3175 BELCHER RD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-9400
Practice Address - Country:US
Practice Address - Phone:727-781-2210
Practice Address - Fax:727-781-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10034310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008766800Medicaid