Provider Demographics
NPI:1437155157
Name:ROCKDALE REGIONAL HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:ROCKDALE REGIONAL HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-446-4500
Mailing Address - Street 1:1701 PECOS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2570
Mailing Address - Country:US
Mailing Address - Phone:512-446-4500
Mailing Address - Fax:
Practice Address - Street 1:1701 PECOS AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2570
Practice Address - Country:US
Practice Address - Phone:512-446-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003484251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457506Medicare ID - Type UnspecifiedPROVIDER NUMBER