Healthcare Provider Details

I. General information

NPI: 1134421456
Provider Name (Legal Business Name): ROCKFORD HEALTHCARE GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BUCKEYE ST
ROCKFORD OH
45882-9266
US

IV. Provider business mailing address

26691 RICHMOND RD
BEDFORD HEIGHTS OH
44146-1421
US

V. Phone/Fax

Practice location:
  • Phone: 419-363-2193
  • Fax:
Mailing address:
  • Phone: 216-292-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2330N
License Number StateOH

VIII. Authorized Official

Name: WILLIAM I WEISBERG
Title or Position: VICE PRESIDENT
Credential:
Phone: 216-292-5706