Healthcare Provider Details

I. General information

NPI: 1417045691
Provider Name (Legal Business Name): ROCK GLEN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N ROCK GLEN RD
BALTIMORE MD
21229-3250
US

IV. Provider business mailing address

PO BOX 40213
BATON ROUGE LA
70835-0213
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-2100
  • Fax: 410-646-2112
Mailing address:
  • Phone: 225-753-0864
  • Fax: 225-753-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30-099
License Number StateMD

VIII. Authorized Official

Name: CINDIE H PITTMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 225-753-0864