Provider Demographics
NPI:1356661326
Name:ROCKER FAMILY GROUP LLC
Entity Type:Organization
Organization Name:ROCKER FAMILY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:ROCKER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:251-645-3448
Mailing Address - Street 1:2520 PECAN POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-6712
Mailing Address - Country:US
Mailing Address - Phone:251-654-9567
Mailing Address - Fax:251-645-3448
Practice Address - Street 1:2520 PECAN POINTE DR
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-6712
Practice Address - Country:US
Practice Address - Phone:251-654-9567
Practice Address - Fax:251-645-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL2072389376251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health