Provider Demographics
NPI:1003220674
Name:EMMANUEL, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:EMMANUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8647 GREENBELT RD
Mailing Address - Street 2:APT 101
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2416
Mailing Address - Country:US
Mailing Address - Phone:240-552-3307
Mailing Address - Fax:
Practice Address - Street 1:8647 GREENBELT RD
Practice Address - Street 2:APT 101
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2416
Practice Address - Country:US
Practice Address - Phone:240-552-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA10869251E00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health