Provider Demographics
NPI:1851058119
Name:RUBY'S NEST: AUTISM SERVICES
Entity type:Organization
Organization Name:RUBY'S NEST: AUTISM SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LADRIDO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:847-418-7501
Mailing Address - Street 1:485 E THORNHILL LN
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-7080
Mailing Address - Country:US
Mailing Address - Phone:847-418-7501
Mailing Address - Fax:
Practice Address - Street 1:485 E THORNHILL LN
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-7080
Practice Address - Country:US
Practice Address - Phone:847-418-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL36375096620Medicaid