Provider Demographics
NPI:1164180576
Name:ODUROE, RUTH
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:ODUROE
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 1:12900 WOODS VIEW ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7101
Mailing Address - Country:US
Mailing Address - Phone:202-929-8025
Mailing Address - Fax:
Practice Address - Street 1:12900 WOODS VIEW ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-7101
Practice Address - Country:US
Practice Address - Phone:202-929-8025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities