Healthcare Provider Details

I. General information

NPI: 1710558820
Provider Name (Legal Business Name): RUBIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E KIOWA ST UNIT 1003
COLORADO SPRINGS CO
80903-8410
US

IV. Provider business mailing address

417 E KIOWA ST UNIT 1003
COLORADO SPRINGS CO
80903-8410
US

V. Phone/Fax

Practice location:
  • Phone: 719-235-8777
  • Fax:
Mailing address:
  • Phone: 719-235-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: THERESA GARCIA
Title or Position: DIRECTOR
Credential:
Phone: 719-235-8777