Provider Demographics
NPI:1831679232
Name:GRAHAM, RUTH
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:GRAHAM
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 1:500 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76704-2230
Mailing Address - Country:US
Mailing Address - Phone:254-733-9794
Mailing Address - Fax:
Practice Address - Street 1:500 PRESTON ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76704-2230
Practice Address - Country:US
Practice Address - Phone:254-733-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health