Provider Demographics
NPI:1366850190
Name:REILLY, RUBY ANN (AGENCY PROVIDER CRMA)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:ANN
Last Name:REILLY
Suffix:
Gender:F
Credentials:AGENCY PROVIDER CRMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 CAIN HL
Mailing Address - Street 2:
Mailing Address - City:PALERMO
Mailing Address - State:ME
Mailing Address - Zip Code:04354-7017
Mailing Address - Country:US
Mailing Address - Phone:207-485-4890
Mailing Address - Fax:
Practice Address - Street 1:127 CAIN HL
Practice Address - Street 2:
Practice Address - City:PALERMO
Practice Address - State:ME
Practice Address - Zip Code:04354-7017
Practice Address - Country:US
Practice Address - Phone:207-485-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health