Provider Demographics
NPI:1891459426
Name:BEN, RICKY
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:BEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4493
Mailing Address - Street 2:
Mailing Address - City:BLUE GAP
Mailing Address - State:AZ
Mailing Address - Zip Code:86520-4493
Mailing Address - Country:US
Mailing Address - Phone:928-679-5408
Mailing Address - Fax:
Practice Address - Street 1:1/4 MI S OF INDIAN RTE 65 FROM WHIPPOORWILL CHAPTER
Practice Address - Street 2:
Practice Address - City:WHIPPOORWILL
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-679-5408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care