Provider Demographics
NPI:1811344708
Name:BUBBLES OF FUN DEVELOPMENTAL THERAPY
Entity type:Organization
Organization Name:BUBBLES OF FUN DEVELOPMENTAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-538-0423
Mailing Address - Street 1:1122 PACKING PLANT RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-7894
Mailing Address - Country:US
Mailing Address - Phone:919-538-0423
Mailing Address - Fax:919-400-4611
Practice Address - Street 1:50 EAGLE RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-7256
Practice Address - Country:US
Practice Address - Phone:919-538-0423
Practice Address - Fax:919-400-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities