Organization
ROCKCREEK, INC.
Active
Other names
LA VINE HOUSE
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE MATTINGLY (MGR PROVIDER ENROLLMENT)
(502) 630-7425
Entity
Organization
Contact information
Practice address
9939 LA VINE ST, ALTA LOMA, CA 91701-5909
(714) 537-3252
Mailing address
805 N WHITTINGTON PKWY, LOUISVILLE, KY 40222-7101
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC60539F
—
CA
Enumeration date
02/27/2007
Last updated
06/19/2024
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