Provider Demographics
NPI:1548349194
Name:ROSEBUSH GARDENS ASSSISTED LIVING
Entity type:Organization
Organization Name:ROSEBUSH GARDENS ASSSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-752-1200
Mailing Address - Street 1:4925 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9469
Mailing Address - Country:US
Mailing Address - Phone:319-752-1200
Mailing Address - Fax:319-752-5800
Practice Address - Street 1:4925 WEST AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9469
Practice Address - Country:US
Practice Address - Phone:319-752-1200
Practice Address - Fax:319-752-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0067310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility