ROCK OF AGES HOME INC NPI 1609945005

NPI Information

NPI: 1609945005
Provider Name: ROCK OF AGES HOME INC
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 35D0408739

Address:
1315 4TH ST NE
JAMESTOWN, ND
ZIP 58401
Phone: (701) 252-9292
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ROCK OF AGES HOME INC is an assisted living facility in Jamestown, ND. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. ROCK OF AGES HOME INC NPI is 1609945005. The provider is registered as an organization entity type.

The provider's business location address is:

1315 4TH ST NE
JAMESTOWN, ND
ZIP 58401-726
Phone: (701) 252-9292
Fax: (701) 252-0417

The provider's authorized official is Tim M Exner .
The authorized official title is Administrator Owner and has the following contact phone number (701) 252-9292.

The CLIA number assigned to this NPI record is 35D0408739 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/7/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		8021B	NORTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	30716	MEDICAID	NORTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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