Provider Demographics
NPI:1669482360
Name:ROCK HOUSE OF GEORGETOWN, INC.
Entity Type:Organization
Organization Name:ROCK HOUSE OF GEORGETOWN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-968-4004
Mailing Address - Street 1:PO BOX 953
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-0009
Mailing Address - Country:US
Mailing Address - Phone:254-968-4004
Mailing Address - Fax:254-965-8653
Practice Address - Street 1:2250-A LINGLEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401
Practice Address - Country:US
Practice Address - Phone:254-968-4004
Practice Address - Fax:254-965-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities