Provider Demographics
NPI:1558413070
Name:LIFF-GRAY, RUTH ELLEN
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:LIFF-GRAY
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 1:207 RUSH ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-9009
Mailing Address - Country:US
Mailing Address - Phone:740-621-2135
Mailing Address - Fax:
Practice Address - Street 1:207 RUSH ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-9009
Practice Address - Country:US
Practice Address - Phone:740-621-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2451494Medicaid