Healthcare Provider Details

I. General information

NPI: 1548858715
Provider Name (Legal Business Name): BERTHA JEAN RUFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 34TH ST NW
CANTON OH
44709-3023
US

IV. Provider business mailing address

425 34TH ST NW
CANTON OH
44709-3023
US

V. Phone/Fax

Practice location:
  • Phone: 330-933-8102
  • Fax:
Mailing address:
  • Phone: 330-933-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: