Provider Demographics
NPI:1760298921
Name:ROC MARIAN ASSISTED LIVING FACILITY, LLC
Entity type:Organization
Organization Name:ROC MARIAN ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERSPOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-227-5519
Mailing Address - Street 1:244 SE VICTORIA GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-9308
Mailing Address - Country:US
Mailing Address - Phone:386-227-5519
Mailing Address - Fax:386-361-2370
Practice Address - Street 1:233 SE COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-4986
Practice Address - Country:US
Practice Address - Phone:386-227-5519
Practice Address - Fax:386-361-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility