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General NPI Number Information
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NPI Number | 1760298921
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Entity Type | Organization
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Legal Business Name | ROC MARIAN ASSISTED LIVING FACILITY, LLC
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 233 SE COUNTRY CLUB RD
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City | LAKE CITY
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State | FL
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Zip | 32025-4986
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Country | US
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Telephone | 386-227-5519
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Fax | 386-361-2370
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Provider Business Mailing Address
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Address Line | 244 SE VICTORIA GLN
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City | LAKE CITY
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State | FL
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Zip | 32025-9308
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Country | US
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Telephone | 386-227-5519
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Fax | 386-361-2370
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Authorized Official
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Title or Position | ADMIN/OWNER
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Name | EMILY WEATHERSPOON
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Credential |
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Telephone | 386-227-5519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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