Provider Demographics
NPI:1356625685
Name:ROCK POINT NURSING CENTER LLC
Entity type:Organization
Organization Name:ROCK POINT NURSING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:PACK
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-614-7472
Mailing Address - Street 1:8477 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:BIRCH TREE
Mailing Address - State:MO
Mailing Address - Zip Code:65438-9215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8477 NORTH STREET
Practice Address - Street 2:
Practice Address - City:BIRCH TREE
Practice Address - State:MO
Practice Address - Zip Code:65438-9215
Practice Address - Country:US
Practice Address - Phone:573-292-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101453603Medicaid