Provider Demographics
NPI:1609418821
Name:SOLID ROCK FAMILY LIFE CENTER, LLC
Entity Type:Organization
Organization Name:SOLID ROCK FAMILY LIFE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-287-3562
Mailing Address - Street 1:123 E TELLIE LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-9720
Mailing Address - Country:US
Mailing Address - Phone:252-287-8713
Mailing Address - Fax:
Practice Address - Street 1:140 W WASHINGTON ST STE 108
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5254
Practice Address - Country:US
Practice Address - Phone:757-539-0315
Practice Address - Fax:757-539-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)