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General NPI Number Information
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NPI Number | 1063526002
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Entity Type | Organization
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Legal Business Name | RUDD RIDGE FAMILY CARE HOME INC.
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 643 RUDD RIDGE RD
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City | YANCEYVILLE
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State | NC
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Zip | 27379-8460
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Country | US
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Telephone | 336-421-7341
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Fax |
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Provider Business Mailing Address
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Address Line | 643 RUDD RIDGE RD
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City | YANCEYVILLE
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State | NC
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Zip | 27379-8460
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-OWNER / ADMINISTRATOR
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Name | MRS. TONYA B. RIBELIN
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Credential |
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Telephone | 336-421-7341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | FCL-017-039
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License Number State | NC
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