Healthcare Provider Details

I. General information

NPI: 1578152187
Provider Name (Legal Business Name): MS. RUTH JEUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUTH JEUNE

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3646 HUDSON LN
BOYNTON BEACH FL
33436-8551
US

IV. Provider business mailing address

3646 HUDSON LN
BOYNTON BEACH FL
33436-8551
US

V. Phone/Fax

Practice location:
  • Phone: 786-278-4303
  • Fax:
Mailing address:
  • Phone: 786-278-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9503116
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: