MEDICARE: RUBIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1710558820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBIS LLC

Provider Business Mailing Address
First Line	:	417 E KIOWA ST UNIT 1003
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-8410
Country	:	US
Telephone Number	:	719-235-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 E KIOWA ST UNIT 1003
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-8410
Country	:	US
Telephone Number	:	719-235-8777
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	THERESA GARCIA
Credential	:
Telephone Number	:	719-235-8777

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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