MEDICARE: TRU TRANSFORMATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1083399794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRU TRANSFORMATION LLC

Provider Business Mailing Address
First Line	:	4711 LIBERTY HEIGHTS AVE FL 1
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-7155
Country	:	US
Telephone Number	:	443-477-0563
Fax Number	:	410-665-4960

Provider Business Practice Location Address
First Line	:	4711 LIBERTY HEIGHTS AVE FL 1
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-7155
Country	:	US
Telephone Number	:	443-477-0563
Fax Number	:	410-665-4960

Authorized Official
Title or Position	:	CEO
Name	:	YOLANDA BROWN
Credential	:	RN
Telephone Number	:	443-477-0563

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “TRU TRANSFORMATION LLC ” Practice Location

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