Healthcare Provider Details

I. General information

NPI: 1306212824
Provider Name (Legal Business Name): ROLLING FIELDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9108 STATE HIGHWAY 198
CONNEAUTVILLE PA
16406-2646
US

IV. Provider business mailing address

9108 STATE HIGHWAY 198
CONNEAUTVILLE PA
16406-2646
US

V. Phone/Fax

Practice location:
  • Phone: 814-587-2012
  • Fax:
Mailing address:
  • Phone: 814-587-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BOSWELL
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 716-338-9766