Organization
ROSEWOOD CARE CENTER, INC OF EDWARDSVILLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY VANDER MATEN (PRESIDENT)
(314) 994-9070
Entity
Organization
Contact information
Practice address
6277 CENTER GROVE RD, EDWARDSVILLE, IL 62025-3309
(618) 659-0605
Mailing address
11701 BORMAN DR, STE 315, SAINT LOUIS, MO 63146-4194
(314) 994-9070
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0041038
IL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
1303700001
IL
Other
Enumeration date
06/16/2005
Last updated
04/20/2008
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