Provider Demographics
NPI:1609870971
Name:ROSELAWN GARDENS NURSING & REHABILITATION, INC.
Entity Type:Organization
Organization Name:ROSELAWN GARDENS NURSING & REHABILITATION, INC.
Other - Org Name:ROSELAWN GARDENS SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-827-0389
Mailing Address - Street 1:70 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44902-1624
Mailing Address - Country:US
Mailing Address - Phone:419-529-7272
Mailing Address - Fax:
Practice Address - Street 1:11999 KLINGER AVE NE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-1116
Practice Address - Country:US
Practice Address - Phone:330-823-0618
Practice Address - Fax:330-821-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1549N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366231Medicare ID - Type Unspecified
OH5485130001Medicare NSC