Provider Demographics
NPI:1700060563
Name:RUBY'S HOMEMAKER SERVICE
Entity Type:Organization
Organization Name:RUBY'S HOMEMAKER SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-847-0383
Mailing Address - Street 1:133 RUBY TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-8933
Mailing Address - Country:US
Mailing Address - Phone:601-847-0383
Mailing Address - Fax:601-847-8094
Practice Address - Street 1:133 RUBY TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-8933
Practice Address - Country:US
Practice Address - Phone:601-847-0383
Practice Address - Fax:601-847-8094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUBY'S HOMEMAKER SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07834201Medicaid