Healthcare Provider Details

I. General information

NPI: 1326619008
Provider Name (Legal Business Name): RUBBYN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24850 GREEN VALLEY ST
SOUTHFIELD MI
48033-3253
US

IV. Provider business mailing address

24850 GREEN VALLEY ST
SOUTHFIELD MI
48033-3253
US

V. Phone/Fax

Practice location:
  • Phone: 248-890-5716
  • Fax:
Mailing address:
  • Phone: 248-890-5716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: RUBBY NWONYE
Title or Position: MANAGING DIRECTOR
Credential: MBA, RHIT
Phone: 248-890-5716