MEDICARE: MAELEE ROSE RUHL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1548775315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAELEE ROSE RUHL

Provider Business Mailing Address
First Line	:	135 OLD FORT RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-9438
Country	:	US
Telephone Number	:	541-274-0721
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 OLD FORT RD
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-9438
Country	:	US
Telephone Number	:	541-274-0721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2017
Last Update Date	:	12/02/2017

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