Provider Demographics
NPI:1114963238
Name:RUTHERFORD LIFE SERVICES INC
Entity Type:Organization
Organization Name:RUTHERFORD LIFE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:QP
Authorized Official - Phone:828-286-4352
Mailing Address - Street 1:230 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:SPINDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28160-2203
Mailing Address - Country:US
Mailing Address - Phone:828-286-4352
Mailing Address - Fax:828-287-3295
Practice Address - Street 1:230 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:SPINDALE
Practice Address - State:NC
Practice Address - Zip Code:28160-2203
Practice Address - Country:US
Practice Address - Phone:828-286-4352
Practice Address - Fax:828-287-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300120Medicaid
NC3408856Medicaid