Provider Demographics
NPI:1679256002
Name:LARUE, RICHARD ALLEN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:LARUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:ARTHURDALE
Mailing Address - State:WV
Mailing Address - Zip Code:26520-0502
Mailing Address - Country:US
Mailing Address - Phone:681-350-5719
Mailing Address - Fax:
Practice Address - Street 1:138 F RD
Practice Address - Street 2:
Practice Address - City:ARTHURDALE
Practice Address - State:WV
Practice Address - Zip Code:26520-0502
Practice Address - Country:US
Practice Address - Phone:681-350-5719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant