Provider Demographics
NPI:1871613562
Name:ROSEGARDEN HEALTH AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:ROSEGARDEN HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-754-4181
Mailing Address - Street 1:600 BOND ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2205
Mailing Address - Country:US
Mailing Address - Phone:203-384-6400
Mailing Address - Fax:203-384-6441
Practice Address - Street 1:3584 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3850
Practice Address - Country:US
Practice Address - Phone:203-754-4181
Practice Address - Fax:203-596-1835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3300314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000021270Medicaid
CT075399AMedicare Oscar/Certification