Provider Demographics
NPI:1538411376
Name:ROCK OF AGES HEALTH CARE SERVICES
Entity type:Organization
Organization Name:ROCK OF AGES HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MR/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:AKUM
Authorized Official - Last Name:MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-829-1119
Mailing Address - Street 1:7059 BLAIR RD NW STE 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1960
Mailing Address - Country:US
Mailing Address - Phone:202-829-1119
Mailing Address - Fax:202-829-0077
Practice Address - Street 1:7059 BLAIR RD NW STE 202
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1960
Practice Address - Country:US
Practice Address - Phone:202-829-1119
Practice Address - Fax:202-829-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health