Organization Name: | ROSEWOOD CARE CENTER, INC OF ALTON |
NPI Number: | 1104821024 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LARRY VANDER MATEN (PRESIDENT) |
Mailing Address: | 3490 Humbert Rd Alton |
State: | IL US |
Postal Code: | 620027101 |
Phone Number: | 6184652626 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2005 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BP3500X |
License Number: | 1303680001 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Parenteral & Enteral Nutrition |
Taxonomy Definition: |