Provider Demographics
NPI:1285097121
Name:RUBY MOUNTAIN RESOURCE CENTER
Entity type:Organization
Organization Name:RUBY MOUNTAIN RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-738-8360
Mailing Address - Street 1:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89803-1708
Mailing Address - Country:US
Mailing Address - Phone:775-738-8360
Mailing Address - Fax:775-753-9686
Practice Address - Street 1:806 RIVER ST
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3842
Practice Address - Country:US
Practice Address - Phone:775-738-8360
Practice Address - Fax:775-753-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAI9005038516Medicaid