Provider Demographics
NPI:1982797817
Name:ROSEWOOD RETIREMENT CENTER INC.
Entity type:Organization
Organization Name:ROSEWOOD RETIREMENT CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCULLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-646-5951
Mailing Address - Street 1:810 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522
Mailing Address - Country:US
Mailing Address - Phone:254-547-9552
Mailing Address - Fax:254-547-9568
Practice Address - Street 1:810 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522
Practice Address - Country:US
Practice Address - Phone:254-547-9552
Practice Address - Fax:254-547-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116899314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004037Medicaid
TX675536Medicare Oscar/Certification