Provider Demographics
NPI:1740664572
Name:ROCK SPRINGS RESIDENTIAL, LLC
Entity type:Organization
Organization Name:ROCK SPRINGS RESIDENTIAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KIERSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-885-6443
Mailing Address - Street 1:81 PILKENTON LN
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-8136
Mailing Address - Country:US
Mailing Address - Phone:573-885-6443
Mailing Address - Fax:573-885-3620
Practice Address - Street 1:81 PILKENTON LN
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-8136
Practice Address - Country:US
Practice Address - Phone:573-885-6443
Practice Address - Fax:573-885-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility