Provider Demographics
NPI:1477860443
Name:ROCK FISH GROUP HOME
Entity Type:Organization
Organization Name:ROCK FISH GROUP HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:N'DAMBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-569-5905
Mailing Address - Street 1:4808 ROCK FISH CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6411
Mailing Address - Country:US
Mailing Address - Phone:813-569-5905
Mailing Address - Fax:
Practice Address - Street 1:4808 ROCK FISH CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-6411
Practice Address - Country:US
Practice Address - Phone:813-569-5905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4563-3GA253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency