Organization
MARIAH RUFFIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAH RUFFIN (OWNER)
(260) 431-1213
Entity
Organization
Contact information
Practice address
1405 ELIZA ST, FORT WAYNE, IN 46803-2035
(260) 431-1213
Mailing address
1405 ELIZA ST, FORT WAYNE, IN 46803-2035
(260) 431-1213
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
385H00000X
Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300022892
—
IN
Enumeration date
04/10/2019
Last updated
04/10/2019
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