Healthcare Provider Details

I. General information

NPI: 1942956677
Provider Name (Legal Business Name): ROCK SOLID, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16806 510TH AVE
MENAHGA MN
56464-3304
US

IV. Provider business mailing address

16806 510TH AVE
MENAHGA MN
56464-3304
US

V. Phone/Fax

Practice location:
  • Phone: 218-255-4817
  • Fax:
Mailing address:
  • Phone: 218-255-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: PATRICK LAKE
Title or Position: PRESIDENT
Credential:
Phone: 218-255-4817