Provider Demographics
NPI:1417596768
Name:ROCK OUT LOUD
Entity Type:Organization
Organization Name:ROCK OUT LOUD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-270-1524
Mailing Address - Street 1:12 US HIGHWAY 9 UNIT 102
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1575
Mailing Address - Country:US
Mailing Address - Phone:732-984-4060
Mailing Address - Fax:
Practice Address - Street 1:12 US HIGHWAY 9 UNIT 102
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1575
Practice Address - Country:US
Practice Address - Phone:732-984-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2020-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)