Provider Demographics
NPI:1659676468
Name:RUDD, ELLA (MHPP)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:RUDD
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 GAP RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-8679
Mailing Address - Country:US
Mailing Address - Phone:870-793-8910
Mailing Address - Fax:870-793-8953
Practice Address - Street 1:1355 EAST MAIN ST.
Practice Address - Street 2:25 GAP RD.
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-2314
Practice Address - Country:US
Practice Address - Phone:870-793-8910
Practice Address - Fax:870-793-8953
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator