Provider Demographics
NPI:1114095130
Name:RUTH'S FOUNDATIONS SHOP
Entity Type:Organization
Organization Name:RUTH'S FOUNDATIONS SHOP
Other - Org Name:NORMA J ENGEMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-686-0656
Mailing Address - Street 1:2823 OAK ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3649
Mailing Address - Country:US
Mailing Address - Phone:541-686-0656
Mailing Address - Fax:541-686-0656
Practice Address - Street 1:2823 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3649
Practice Address - Country:US
Practice Address - Phone:541-686-0656
Practice Address - Fax:541-686-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR044917Medicaid
OR044917Medicaid