MEDICARE: RUBY ELEANOR HALFACRE

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1629862503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY ELEANOR HALFACRE

Provider Business Mailing Address
First Line	:	8022 WETHERSFIELD CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-9142
Country	:	US
Telephone Number	:	941-920-8335
Fax Number	:

Provider Business Practice Location Address
First Line	:	8022 WETHERSFIELD CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-9142
Country	:	US
Telephone Number	:	941-920-8335
Fax Number	:

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

Provider Enumeration Date	:	04/07/2025
Last Update Date	:	04/07/2025

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Directions to “ RUBY ELEANOR HALFACRE ” Practice Location

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