Provider Demographics
NPI:1053436758
Name:RUDD ROCKFORD MARBLE ROCK
Entity type:Organization
Organization Name:RUDD ROCKFORD MARBLE ROCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-756-3610
Mailing Address - Street 1:1460 210TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50468-8192
Mailing Address - Country:US
Mailing Address - Phone:641-756-3610
Mailing Address - Fax:641-756-2369
Practice Address - Street 1:1460 210TH ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IA
Practice Address - Zip Code:50468-8192
Practice Address - Country:US
Practice Address - Phone:641-756-3610
Practice Address - Fax:641-756-2369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0427062Medicaid