Provider Demographics
NPI:1174369284
Name:DORA AND RUBY
Entity type:Organization
Organization Name:DORA AND RUBY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-987-4575
Mailing Address - Street 1:33432 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3537
Mailing Address - Country:US
Mailing Address - Phone:248-987-4575
Mailing Address - Fax:
Practice Address - Street 1:33432 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-3537
Practice Address - Country:US
Practice Address - Phone:248-987-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health