=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689736530
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANICE RUFFIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31029 RICHERT
-----------------------------------------------------
City | FRASER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48026-2734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-388-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18657 HASSE ST
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48234-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-388-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------