=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396366019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RTS PRACTITIONER STAFFING SERVICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2020
-----------------------------------------------------
Last Update Date | 05/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26631 SOUTHFIELD RD
-----------------------------------------------------
City | LATHRUP VILLAGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-4530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-569-7550
-----------------------------------------------------
Fax | 248-569-7552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26631 SOUTHFIELD RD
-----------------------------------------------------
City | LATHRUP VILLAGE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48076-4530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-569-7550
-----------------------------------------------------
Fax | 248-569-7552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | YOLANDA YVETTE CUFF
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 586-525-9080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------