MEDICARE: THE ROCK HOME CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1629707781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ROCK HOME CARE INC

Provider Business Mailing Address
First Line	:	979 BAY STREET STATEN ISLAND NEW YORK, 10305
Second Line	:	SUITE #4
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4903
Country	:	US
Telephone Number	:	917-830-0201
Fax Number	:	917-830-0201

Provider Business Practice Location Address
First Line	:	979 BAY STREET RM #4, STATEN ISLAND NEW YORK, 10305
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4903
Country	:	US
Telephone Number	:	917-830-0201
Fax Number	:	917-830-0201

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MRS. HALIMATTU MARIAM FODAY-KAKPA
Credential	:	THE ROCK HOME CARE
Telephone Number	:	347-879-1195

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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