Provider Demographics
NPI:1194159533
Name:RUTH CARE
Entity type:Organization
Organization Name:RUTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE GIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-671-5810
Mailing Address - Street 1:4812 S 86TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7126
Mailing Address - Country:US
Mailing Address - Phone:813-671-5810
Mailing Address - Fax:
Practice Address - Street 1:4812 S 86TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7126
Practice Address - Country:US
Practice Address - Phone:813-671-5810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905097311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141477100Medicaid