Provider Demographics
NPI:1285939074
Name:HARRIS, RUBIE JEWEL (LVN)
Entity type:Individual
Prefix:
First Name:RUBIE
Middle Name:JEWEL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 GLOUCESTER ST S
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-7511
Mailing Address - Country:US
Mailing Address - Phone:972-841-3293
Mailing Address - Fax:
Practice Address - Street 1:1028 GLOUCESTER ST S
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-7511
Practice Address - Country:US
Practice Address - Phone:972-841-3293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123937310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility