Healthcare Provider Details

I. General information

NPI: 1659951036
Provider Name (Legal Business Name): TRUCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2021
Last Update Date: 08/08/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 PROMENADE WAY APT 210
PORTAGE IN
46368-2965
US

IV. Provider business mailing address

2545 PROMENADE WAY APT 210
PORTAGE IN
46368-2965
US

V. Phone/Fax

Practice location:
  • Phone: 219-318-3116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: CHRYSTAL ANDERSON
Title or Position: CEO/ WAIVER PROVIDER
Credential:
Phone: 219-318-3116