Provider Demographics
NPI:1467409060
Name:ROCK OF AGES, INC
Entity Type:Organization
Organization Name:ROCK OF AGES, INC
Other - Org Name:ROCK OF AGES HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AKEEM
Authorized Official - Middle Name:OLUWASEGUN
Authorized Official - Last Name:AKINBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-674-1858
Mailing Address - Street 1:PO BOX 10057
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914-0057
Mailing Address - Country:US
Mailing Address - Phone:877-699-0762
Mailing Address - Fax:301-830-6776
Practice Address - Street 1:812 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4870
Practice Address - Country:US
Practice Address - Phone:877-699-0762
Practice Address - Fax:301-830-6776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2255251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD409589800Medicaid