Provider Demographics
NPI:1427059435
Name:T.J ROCK ENTERPRISES, INC.
Entity type:Organization
Organization Name:T.J ROCK ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:ALBAN
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, NHA
Authorized Official - Phone:301-831-4128
Mailing Address - Street 1:5800 GENESIS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-5116
Mailing Address - Country:US
Mailing Address - Phone:301-831-4128
Mailing Address - Fax:301-831-4281
Practice Address - Street 1:5800 GENESIS LN
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-5116
Practice Address - Country:US
Practice Address - Phone:301-831-4128
Practice Address - Fax:301-831-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD219003Medicare ID - Type Unspecified