Healthcare Provider Details

I. General information

NPI: 1164270849
Provider Name (Legal Business Name): ROCKER COMMUNITY HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10681 LAGO WELLEBY DR
SUNRISE FL
33351-8287
US

IV. Provider business mailing address

10681 LAGO WELLEBY DR
SUNRISE FL
33351-8287
US

V. Phone/Fax

Practice location:
  • Phone: 786-355-8680
  • Fax:
Mailing address:
  • Phone: 786-355-8680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFF ROCKER
Title or Position: PRESIDENT
Credential: PH.D
Phone: 786-355-8680