Provider Demographics
NPI:1821477571
Name:ROBYN RUGGEROLI
Entity Type:Organization
Organization Name:ROBYN RUGGEROLI
Other - Org Name:SELF
Other - Org Type:Other Name
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGGEROLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-807-4592
Mailing Address - Street 1:1501 LOST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-9138
Mailing Address - Country:US
Mailing Address - Phone:702-807-4592
Mailing Address - Fax:
Practice Address - Street 1:1501 LOST CREEK DR
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-9138
Practice Address - Country:US
Practice Address - Phone:702-807-4592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services