MEDICARE: ROCKFORD NH 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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1700329240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKFORD NH LLC

Provider Business Mailing Address
First Line	:	1660 S MULFORD RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-6760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 S MULFORD RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-6760
Country	:	US
Telephone Number	:	815-397-8700
Fax Number	:	815-397-4880

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES BOLICK
Credential	:
Telephone Number	:	212-649-9705

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	06/25/2021

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Directions to “ROCKFORD NH LLC ” Practice Location

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