1366721946 NPI number — RUBY'S PERSONAL HOME CARE LLC.

Table of content: DIANA MARGARITA MALDONADO, LVN (NPI 1003393711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366721946 NPI number — RUBY'S PERSONAL HOME CARE LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUBY'S PERSONAL HOME CARE LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366721946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2117 FIELDSTONE VIEW CT SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONYERS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30013-6755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-679-5482
Provider Business Mailing Address Fax Number:
770-679-0619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2625 FIELDSTONE VIEW LN SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30013-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-679-5482
Provider Business Practice Location Address Fax Number:
770-679-0619
Provider Enumeration Date:
08/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LAWES
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/OWNER
Authorized Official Telephone Number:
770-679-5482

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , with the licence number:  PCH005620 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PCH005620 . This is a "GEORGIA DEPARTMENT OF COMMUNITY HEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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