Provider Demographics
NPI:1427659960
Name:RUBY DONALD RESIDENTIAL CARE LLC
Entity type:Organization
Organization Name:RUBY DONALD RESIDENTIAL CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BEAUTY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-394-6933
Mailing Address - Street 1:16 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4006
Mailing Address - Country:US
Mailing Address - Phone:404-394-6933
Mailing Address - Fax:864-752-1084
Practice Address - Street 1:2 RUBY DONALD PLACE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617
Practice Address - Country:US
Practice Address - Phone:864-905-1768
Practice Address - Fax:864-752-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care