Provider Demographics
NPI:1578900841
Name:RUCKER HOLDINGS INC
Entity Type:Organization
Organization Name:RUCKER HOLDINGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-877-3202
Mailing Address - Street 1:481 ELMA G MILES PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4004
Mailing Address - Country:US
Mailing Address - Phone:912-877-3202
Mailing Address - Fax:912-877-3206
Practice Address - Street 1:522 ELMA G MILES PKWY STE B
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4021
Practice Address - Country:US
Practice Address - Phone:912-877-3202
Practice Address - Fax:912-877-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA6904720001Medicare NSC