Healthcare Provider Details

I. General information

NPI: 1912861626
Provider Name (Legal Business Name): TRUCARE 360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 BOBWHITE DR
CORDELE GA
31015-5116
US

IV. Provider business mailing address

103 BOBWHITE DR
CORDELE GA
31015-5116
US

V. Phone/Fax

Practice location:
  • Phone: 404-855-1022
  • Fax:
Mailing address:
  • Phone: 404-855-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 770-203-5199