Healthcare Provider Details

I. General information

NPI: 1114095130
Provider Name (Legal Business Name): RUTH'S FOUNDATIONS SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 OAK ST
EUGENE OR
97405-3649
US

IV. Provider business mailing address

2823 OAK ST
EUGENE OR
97405-3649
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-0656
  • Fax: 541-686-0656
Mailing address:
  • Phone: 541-686-0656
  • Fax: 541-686-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier044917
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: MS. NORMA J ENGEMAN
Title or Position: OWNER
Credential:
Phone: 541-686-0656