Provider Demographics
NPI:1821394313
Name:BUDHOO, RUDENE JACKSON (EXECUTIVE DIRECTOR)
Entity Type:Individual
Prefix:
First Name:RUDENE
Middle Name:JACKSON
Last Name:BUDHOO
Suffix:
Gender:F
Credentials:EXECUTIVE DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KENNEDY RD
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-5906
Mailing Address - Country:US
Mailing Address - Phone:803-635-2736
Mailing Address - Fax:803-633-8187
Practice Address - Street 1:14 KENNEDY RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180-5906
Practice Address - Country:US
Practice Address - Phone:803-635-2736
Practice Address - Fax:803-633-8187
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker