Healthcare Provider Details

I. General information

NPI: 1265352843
Provider Name (Legal Business Name): THE RUBY-NELL AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22810 30TH AVE S UNIT B203
DES MOINES WA
98198-7298
US

IV. Provider business mailing address

22810 30TH AVE S UNIT B203
DES MOINES WA
98198-7298
US

V. Phone/Fax

Practice location:
  • Phone: 206-572-5771
  • Fax: 206-338-9964
Mailing address:
  • Phone: 206-572-5771
  • Fax: 206-338-9964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLENE BORDERS
Title or Position: LEAD COORDINATOR
Credential: BORDERS
Phone: 206-572-5771