MEDICARE: ROCK GLEN HEALTHCARE, INC.

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	314000000X	Skilled Nursing Facility	30-099	MD

General Provider Information

NPI Number	:	1417045691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK GLEN HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 40213
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70835-0213
Country	:	US
Telephone Number	:	225-753-0864
Fax Number	:	225-753-0948

Provider Business Practice Location Address
First Line	:	10 N ROCK GLEN RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-3250
Country	:	US
Telephone Number	:	410-646-2100
Fax Number	:	410-646-2112

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	CINDIE H PITTMAN
Credential	:
Telephone Number	:	225-753-0864

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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Directions to “ROCK GLEN HEALTHCARE, INC. ” Practice Location

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