Ruby Jewells Legacy LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

RUBY JEWELLS LEGACY LLC

Practice address

3007 Lombard Dr
Wichita Falls, TX 76309-4727

Phone

(989) 714-6562

NPI assigned

Nov 20, 2018

Last updated

Feb 12, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Taniqua Blakely

Title

Owner/Program Manager

Phone

(989) 714-6562

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1932678869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3007 LOMBARD DR",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763094727",
            "telephone_number": "989-714-6562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3007 LOMBARD DR",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763094727",
            "telephone_number": "989-714-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RUBY JEWELLS LEGACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-20",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "BLAKELY",
        "authorized_official_first_name": "TANIQUA",
        "authorized_official_title_or_position": "OWNER/PROGRAM MANAGER",
        "authorized_official_telephone_number": "989-714-6562"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wichita Falls, TX
• Providers in Wichita Falls, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.