Individual
ANNETTE JOHNSON-RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3294 E 104TH ST, CLEVELAND, OH 44104-5646
(216) 322-3006
Mailing address
1037 EAST BLVD, CLEVELAND, OH 44108-2972
(216) 322-3006
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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