MEDICARE: EAST ROCKETS HH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1104526771
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST ROCKETS HH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4060
Second Line	:
City	:	MOORESVILLE
State	:	NC
Zip	:	28117-4060
Country	:	US
Telephone Number	:	704-664-2876
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 NORTH STREET
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-0400
Country	:	US
Telephone Number	:	740-259-6571
Fax Number	:

Authorized Official
Title or Position	:	VP OF LICENSURE
Name	:	JANET COMBS
Credential	:
Telephone Number	:	704-664-2876

Provider Enumeration Date	:	03/03/2023
Last Update Date	:	07/03/2024

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