Provider Demographics
NPI:1629306261
Name:ROCK ARCH REFUGE, INC.
Entity Type:Organization
Organization Name:ROCK ARCH REFUGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:NATIONS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:859-749-9180
Mailing Address - Street 1:141 SUNSHINE RD
Mailing Address - Street 2:
Mailing Address - City:ZOE
Mailing Address - State:KY
Mailing Address - Zip Code:41397-9739
Mailing Address - Country:US
Mailing Address - Phone:606-464-9255
Mailing Address - Fax:
Practice Address - Street 1:141 SUNSHINE RD
Practice Address - Street 2:
Practice Address - City:ZOE
Practice Address - State:KY
Practice Address - Zip Code:41397-9739
Practice Address - Country:US
Practice Address - Phone:606-464-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child