Healthcare Provider Details

I. General information

NPI: 1578706990
Provider Name (Legal Business Name): TRULIFE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 LORD BALTIMORE DR STE 200
WINDSOR MILL MD
21244-2659
US

IV. Provider business mailing address

1502 WOODLAWN DR STE 103
WOODLAWN MD
21207-4022
US

V. Phone/Fax

Practice location:
  • Phone: 410-298-3431
  • Fax: 410-298-3934
Mailing address:
  • Phone: 410-298-3431
  • Fax: 410-298-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberR2736P
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALFRED EZEKWESILI
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-298-3431