Provider Demographics
NPI:1134185804
Name:ROSEWOOD MANOR INC
Entity type:Organization
Organization Name:ROSEWOOD MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-905-5200
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-0010
Mailing Address - Country:US
Mailing Address - Phone:731-847-6343
Mailing Address - Fax:731-847-4200
Practice Address - Street 1:1400 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4878
Practice Address - Country:US
Practice Address - Phone:931-388-6573
Practice Address - Fax:931-540-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000184314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN744-0534Medicaid
TN445432Medicare Oscar/Certification