Healthcare Provider Details

I. General information

NPI: 1922533520
Provider Name (Legal Business Name): TRU TRANSITIONAL RESOURCES UNITED INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2017
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6639 W HOLLILYNN DR
BOISE ID
83709-7271
US

IV. Provider business mailing address

PO BOX 45474
BOISE ID
83711-5474
US

V. Phone/Fax

Practice location:
  • Phone: 208-598-8781
  • Fax:
Mailing address:
  • Phone: 208-598-8781
  • Fax: 208-279-8881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateID

VIII. Authorized Official

Name: MR. RASHEED AMINE RYALS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 325-650-5846