Provider Demographics
NPI:1457865628
Name:RUTH'S AND HATTIE'S GRANDDAUGHTER, LLC
Entity Type:Organization
Organization Name:RUTH'S AND HATTIE'S GRANDDAUGHTER, LLC
Other - Org Name:COMFORT KEEPERS #1027
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SOURS
Authorized Official - Last Name:CUBBAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:540-773-2211
Mailing Address - Street 1:3042 VALLEY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2669
Mailing Address - Country:US
Mailing Address - Phone:540-773-2211
Mailing Address - Fax:540-773-2866
Practice Address - Street 1:3042 VALLEY AVE STE 102
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2669
Practice Address - Country:US
Practice Address - Phone:540-773-2211
Practice Address - Fax:540-773-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS698774-9OtherSTATE CORPORATION COMMISSION
VA14-=========F-001OtherCONSUMER USE TAX
VA30-=========F-001OtherEMPLOYER WITHHOLDING TAX
VAS698774-9OtherSTATE CORPORATION COMMISSION