Provider Demographics
NPI:1346075736
Name:ROCK OF AGES NURSING SERVICES LLC
Entity type:Organization
Organization Name:ROCK OF AGES NURSING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:MOMBO
Authorized Official - Last Name:AIYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-946-1291
Mailing Address - Street 1:10302 SNOWDEN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3122
Mailing Address - Country:US
Mailing Address - Phone:240-946-1291
Mailing Address - Fax:
Practice Address - Street 1:10302 SNOWDEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3122
Practice Address - Country:US
Practice Address - Phone:240-946-1291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No251J00000XAgenciesNursing Care