Provider Demographics
NPI:1417045691
Name:ROCK GLEN HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ROCK GLEN HEALTHCARE, INC.
Other - Org Name:ROCK GLEN NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CINDIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-753-0864
Mailing Address - Street 1:PO BOX 40213
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70835-0213
Mailing Address - Country:US
Mailing Address - Phone:225-753-0864
Mailing Address - Fax:225-753-0948
Practice Address - Street 1:10 N ROCK GLEN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3250
Practice Address - Country:US
Practice Address - Phone:410-646-2100
Practice Address - Fax:410-646-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-099314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215299Medicare ID - Type Unspecified