Provider Demographics
NPI:1992243042
Name:RUTH'S HOME LLC
Entity type:Organization
Organization Name:RUTH'S HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:TINO
Authorized Official - Last Name:DITOMASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-304-9618
Mailing Address - Street 1:2811 LAMBERT RD
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922-9505
Mailing Address - Country:US
Mailing Address - Phone:509-304-9618
Mailing Address - Fax:509-674-4007
Practice Address - Street 1:304 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1212
Practice Address - Country:US
Practice Address - Phone:509-304-9618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA752404302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization