MEDICARE: TRU LIFE TRAINING, 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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1770926693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRU LIFE TRAINING, LLC

Provider Business Mailing Address
First Line	:	PO BOX 62825
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23466-2825
Country	:	US
Telephone Number	:	757-751-0413
Fax Number	:

Provider Business Practice Location Address
First Line	:	4544 GENOA CIR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3154
Country	:	US
Telephone Number	:	757-751-0413
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. NORRIS SHERMON
Credential	:
Telephone Number	:	757-751-0413

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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