MEDICARE: ROCK CARE DIRECT, 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	LC1302740	MO

General Provider Information

NPI Number	:	1881035970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCK CARE DIRECT, LLC

Provider Business Mailing Address
First Line	:	204 S UNION AVE
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-1949
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 S UNION AVE
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-1949
Country	:	US
Telephone Number	:	573-204-7620
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. THOMAS D. WHITE
Credential	:
Telephone Number	:	573-204-7620

Provider Enumeration Date	:	07/17/2013
Last Update Date	:	07/17/2013

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