MEDICARE: RUBY BEHAVIORAL SERVICES - SOUTH CAROLINA 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1871231951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBY BEHAVIORAL SERVICES - SOUTH CAROLINA LLC

Provider Business Mailing Address
First Line	:	141 TRACTION ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4725
Country	:	US
Telephone Number	:	800-459-1078
Fax Number	:	562-265-0906

Provider Business Practice Location Address
First Line	:	141 TRACTION ST
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-4725
Country	:	US
Telephone Number	:	800-459-1078
Fax Number	:	562-265-0906

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ELIZABETH TERESA SEQUEIRA
Credential	:	MED, BCBA
Telephone Number	:	919-600-2246

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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