Provider Demographics
NPI:1154403251
Name:ROCK OF AGES HOME HEALTH CARE INC
Entity type:Organization
Organization Name:ROCK OF AGES HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWABEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-840-2222
Mailing Address - Street 1:346 OAKS TRL STE 205
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4095
Mailing Address - Country:US
Mailing Address - Phone:972-840-2222
Mailing Address - Fax:972-840-3311
Practice Address - Street 1:346 OAKS TRAIL
Practice Address - Street 2:SUITE 205
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1664
Practice Address - Country:US
Practice Address - Phone:972-840-2222
Practice Address - Fax:972-840-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459468Medicare Oscar/Certification
459468Medicare Oscar/Certification
TX1982702296Medicare ID - Type Unspecified