Healthcare Provider Details

I. General information

NPI: 1043780083
Provider Name (Legal Business Name): TRU EAST DIGNITY HOMECARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 01/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N LINKS DR APT 1061
AVONDALE AZ
85323-3046
US

IV. Provider business mailing address

3420 E SHEA BLVD STE 200
PHOENIX AZ
85028-3348
US

V. Phone/Fax

Practice location:
  • Phone: 480-487-8480
  • Fax: 602-595-9977
Mailing address:
  • Phone: 29-535-3766
  • Fax: 602-595-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. JIMMY LEE ELLIS
Title or Position: PRESIDENT
Credential:
Phone: 480-487-8480