Provider Demographics
NPI:1255791471
Name:FG ROQUE HEALTHCARE SERVICES, INC.
Entity type:Organization
Organization Name:FG ROQUE HEALTHCARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FELINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROQUE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:408-262-8801
Mailing Address - Street 1:620 S. DORA AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5482
Mailing Address - Country:US
Mailing Address - Phone:408-262-8801
Mailing Address - Fax:
Practice Address - Street 1:620 S. DORA AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5482
Practice Address - Country:US
Practice Address - Phone:408-262-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health