MEDICARE: ROCK OF AGES NURSING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1700485695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK OF AGES NURSING SERVICES LLC

Provider Business Mailing Address
First Line	:	10302 SNOWDEN RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-3122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10302 SNOWDEN RD
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-3122
Country	:	US
Telephone Number	:	717-318-1851
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	FLORENCE AIYUK
Credential	:
Telephone Number	:	717-318-1851

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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