Healthcare Provider Details

I. General information

NPI: 1467386987
Provider Name (Legal Business Name): ROCK OF REFUGE ROOM AND BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CAMPBELL AVE
VALLEJO CA
94590-7104
US

IV. Provider business mailing address

333 CAMPBELL AVE
VALLEJO CA
94590-7104
US

V. Phone/Fax

Practice location:
  • Phone: 510-837-0364
  • Fax:
Mailing address:
  • Phone: 510-837-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: RUTH E ZELEDON
Title or Position: CAREGIVER
Credential:
Phone: 510-837-0364