Healthcare Provider Details

I. General information

NPI: 1922437508
Provider Name (Legal Business Name): ROCKINGHAM HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 MALLARD LN
ROCKINGHAM NC
28379-5203
US

IV. Provider business mailing address

612 HEALTH DR
RAEFORD NC
28376-2540
US

V. Phone/Fax

Practice location:
  • Phone: 910-895-0750
  • Fax:
Mailing address:
  • Phone: 910-875-4551
  • Fax: 910-875-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberHAL-077-011
License Number StateNC

VIII. Authorized Official

Name: MR. JOHN LEANDRO
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 910-479-7919