Provider Demographics
NPI:1932625803
Name:ROCK, TAMMY (HHA , PCA , CDS)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ROCK
Suffix:
Gender:F
Credentials:HHA , PCA , CDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2081 ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:KEESEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12944-4107
Mailing Address - Country:US
Mailing Address - Phone:518-578-7290
Mailing Address - Fax:
Practice Address - Street 1:2081 ROUTE 22
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944-4107
Practice Address - Country:US
Practice Address - Phone:518-578-7290
Practice Address - Fax:518-314-1223
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion