Provider Demographics
NPI:1871231951
Name:RUBY BEHAVIORAL SERVICES - SOUTH CAROLINA LLC
Entity Type:Organization
Organization Name:RUBY BEHAVIORAL SERVICES - SOUTH CAROLINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:SEQUEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:919-600-2246
Mailing Address - Street 1:141 TRACTION ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-4725
Mailing Address - Country:US
Mailing Address - Phone:800-459-1078
Mailing Address - Fax:562-265-0906
Practice Address - Street 1:141 TRACTION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-4725
Practice Address - Country:US
Practice Address - Phone:800-459-1078
Practice Address - Fax:562-265-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty