MEDICARE: RUITER CONSTRUCTION, 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	171WH0202X	Home Modifications Contractor

General Provider Information

NPI Number	:	1770245698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUITER CONSTRUCTION, LLC

Provider Business Mailing Address
First Line	:	3355 PALMS CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5663
Country	:	US
Telephone Number	:	702-252-4069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 PALMS CENTER DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5663
Country	:	US
Telephone Number	:	702-252-4069
Fax Number	:

Authorized Official
Title or Position	:	ADMIRATIVE ASSISTANT
Name	:	MRS. KELLY MARIE KNELL
Credential	:
Telephone Number	:	702-252-4069

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	10/07/2021

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