Individual ProviderEllie RockDietitian, RegisteredDietary & Nutritional Service ProvidersPractice Address5424 N Sun Shimmer Ave, Meridian, ID 83646-5536(208) 351-4640PECOS EnrollmentBased on the most recent information from CMS, provider Ellie Rock does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1992310148Provider TypeIndividualFull NameRock, EllieTitleMs.CredentialRDN, LDGenderFemaleSole ProprietorYesEnumeration Date9/14/2020Last Updated9/24/2020Contact InformationPractice LocationPractice Address5424 N Sun Shimmer Ave, Meridian, ID 83646-5536Phone(208) 351-4640FaxUnlisted FaxMailing LocationMailing Address5424 N Sun Shimmer Ave, Meridian, ID 83646-5536Phone(208) 351-4640FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode133V00000XPrimaryDescriptionDietitian, RegisteredDietary & Nutritional Service ProvidersLicenseD-626Idaho