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General NPI Number Information
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NPI Number | 1891235453
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Entity Type | Organization
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Legal Business Name | ROCKGATE ASSISTED LIVING FACILITY LLC
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 328 CUMBERLAND ST W
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City | COWAN
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State | TN
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Zip | 37318-3112
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Country | US
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Telephone | 931-962-9777
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Fax | 931-962-9911
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Provider Business Mailing Address
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Address Line | 328 CUMBERLAND ST W
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City | COWAN
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State | TN
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Zip | 37318-3112
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Country | US
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Telephone | 931-962-9777
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Fax | 931-962-9911
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALLEN REDMON
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Credential |
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Telephone | 931-962-9777
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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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