Provider Demographics
NPI:1851586390
Name:ROSEWOOD VILLAGE REHAB SERVICES,LLC
Entity Type:Organization
Organization Name:ROSEWOOD VILLAGE REHAB SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:434-975-5079
Mailing Address - Street 1:500 GREENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1682
Mailing Address - Country:US
Mailing Address - Phone:434-975-5079
Mailing Address - Fax:434-975-9079
Practice Address - Street 1:500 GREENBRIER DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1682
Practice Address - Country:US
Practice Address - Phone:434-975-5079
Practice Address - Fax:434-975-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203570261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10385Medicare PIN