Healthcare Provider Details

I. General information

NPI: 1982954293
Provider Name (Legal Business Name): CATHERINE RULE CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 DUNLAP ST
SANTA FE NM
87501-2416
US

IV. Provider business mailing address

936 DUNLAP ST
SANTA FE NM
87501-2416
US

V. Phone/Fax

Practice location:
  • Phone: 413-626-6850
  • Fax: 413-517-0567
Mailing address:
  • Phone: 413-626-6850
  • Fax: 413-517-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number00043481
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: