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Organization

EXTENDED CARE SPECIALISTS, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER RUCCI MD (OWNER)
(855) 743-2247
Entity
Organization

Contact information

Practice address
3512 STELLHORN RD, FORT WAYNE, IN 46815
(260) 483-9081
(260) 483-9196
Mailing address
PO BOX 392552, PITTSBURGH, PA 15251-9552
(260) 483-9081
(260) 483-9196

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
103TC0700X
Clinical Psychologist
1041C0700X
Clinical Social Worker
207QA0505X
Adult Medicine Physician
Primary
207R00000X
Internal Medicine Physician
2084P0800X
Psychiatry Physician
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner
363LA2200X
Adult Health Nurse Practitioner
363LF0000X
Family Nurse Practitioner

Other

Enumeration date
07/16/2006
Last updated
09/30/2024
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