Provider Demographics
NPI:1144769993
Name:RUBY SLIPPERS WELLNESS
Entity Type:Organization
Organization Name:RUBY SLIPPERS WELLNESS
Other - Org Name:RUBY HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNAE
Authorized Official - Middle Name:ADRIEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:541-497-3885
Mailing Address - Street 1:581 W 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3816
Mailing Address - Country:US
Mailing Address - Phone:541-497-3885
Mailing Address - Fax:844-517-6506
Practice Address - Street 1:581 W 17TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3816
Practice Address - Country:US
Practice Address - Phone:541-497-3885
Practice Address - Fax:844-517-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500726016Medicaid