Provider Demographics
NPI:1285980672
Name:SELF RELIANCE, INC
Entity type:Organization
Organization Name:SELF RELIANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-375-3965
Mailing Address - Street 1:8901 N ARMENIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1041
Mailing Address - Country:US
Mailing Address - Phone:813-375-3965
Mailing Address - Fax:813-375-3970
Practice Address - Street 1:8901 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1041
Practice Address - Country:US
Practice Address - Phone:813-375-3965
Practice Address - Fax:813-375-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management