Provider Demographics
NPI:1023639499
Name:JACQUE RUCH, LLC
Entity type:Organization
Organization Name:JACQUE RUCH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW 8152438332
Authorized Official - Phone:815-243-8332
Mailing Address - Street 1:11519 SWEETGRASS DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2522
Mailing Address - Country:US
Mailing Address - Phone:815-243-8332
Mailing Address - Fax:
Practice Address - Street 1:3205 SOUTHGATE CIR STE 19
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-5514
Practice Address - Country:US
Practice Address - Phone:815-243-8332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty