1144769993 NPI number — RUBY SLIPPERS WELLNESS

Table of content: (NPI 1144769993)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144769993 NPI number — RUBY SLIPPERS WELLNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUBY SLIPPERS WELLNESS
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:
6
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:
1144769993
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
581 W 17TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97401-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-497-3885
Provider Business Mailing Address Fax Number:
844-517-6506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
581 W 17TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-497-3885
Provider Business Practice Location Address Fax Number:
844-517-6506
Provider Enumeration Date:
02/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
LYNAE
Authorized Official Middle Name:
ADRIEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-497-3885

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500726016 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com