Provider Demographics
NPI:1790361442
Name:CHRIST THE ROCK HOMECARE
Entity Type:Organization
Organization Name:CHRIST THE ROCK HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-BC
Authorized Official - Phone:347-397-1987
Mailing Address - Street 1:210 CUTBANK CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-3882
Mailing Address - Country:US
Mailing Address - Phone:347-397-1987
Mailing Address - Fax:
Practice Address - Street 1:210 CUTBANK CT SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-3882
Practice Address - Country:US
Practice Address - Phone:347-397-1987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility