Provider Demographics
NPI:1932194610
Name:ROCKVILLE NURSING HOME, INC.
Entity Type:Organization
Organization Name:ROCKVILLE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCCUBBIN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:301-279-9000
Mailing Address - Street 1:303 ADCLARE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3825
Mailing Address - Country:US
Mailing Address - Phone:301-279-9000
Mailing Address - Fax:301-762-6881
Practice Address - Street 1:303 ADCLARE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3825
Practice Address - Country:US
Practice Address - Phone:301-279-9000
Practice Address - Fax:301-762-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15-019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD155997400Medicaid
MD215107Medicare ID - Type UnspecifiedFACILITY MEDICARE NUMBER