Healthcare Provider Details

I. General information

NPI: 1538758446
Provider Name (Legal Business Name): TRUCARE BOARDING HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9367 SISKIN AVE
FOUNTAIN VALLEY CA
92708-6553
US

IV. Provider business mailing address

9367 SISKIN AVE
FOUNTAIN VALLEY CA
92708-6553
US

V. Phone/Fax

Practice location:
  • Phone: 626-380-6863
  • Fax:
Mailing address:
  • Phone: 626-380-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NATHAN QUY
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 626-380-6863