Provider Demographics
NPI:1972310951
Name:RUCKS, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:RUCKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALVIN
Other - Middle Name:LE ANDRE
Other - Last Name:RUCKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8217
Mailing Address - Country:US
Mailing Address - Phone:870-777-9051
Mailing Address - Fax:870-777-3104
Practice Address - Street 1:715 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4403
Practice Address - Country:US
Practice Address - Phone:870-312-6873
Practice Address - Fax:870-777-3104
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator