Provider Demographics
NPI:1093569311
Name:ROCK OF AGES ADULT FAMILY HOME LLC
Entity Type:Organization
Organization Name:ROCK OF AGES ADULT FAMILY HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GITAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-765-3589
Mailing Address - Street 1:7224 N DRUMHELLER ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-4918
Mailing Address - Country:US
Mailing Address - Phone:253-765-3589
Mailing Address - Fax:
Practice Address - Street 1:7224 N DRUMHELLER ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4918
Practice Address - Country:US
Practice Address - Phone:253-765-3589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency