Provider Demographics
NPI:1366936395
Name:ROCK OF AGES CARE SERVICES LLC
Entity type:Organization
Organization Name:ROCK OF AGES CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMILOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLOFINLUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-605-6949
Mailing Address - Street 1:13 C ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4152
Mailing Address - Country:US
Mailing Address - Phone:800-605-6949
Mailing Address - Fax:
Practice Address - Street 1:13 C ST STE B
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4152
Practice Address - Country:US
Practice Address - Phone:800-605-6949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCK OF AGES CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health