Healthcare Provider Details

I. General information

NPI: 1982702932
Provider Name (Legal Business Name): TRU HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NORTHWOODS DR STE 240
ARDEN HILLS MN
55112-6991
US

IV. Provider business mailing address

3900 NORTHWOODS DR STE 240
ARDEN HILLS MN
55112-6991
US

V. Phone/Fax

Practice location:
  • Phone: 651-285-0135
  • Fax: 651-633-7301
Mailing address:
  • Phone: 651-285-0135
  • Fax: 651-633-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number430029700
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIM LIVELY
Title or Position: PRESIDENT
Credential:
Phone: 651-789-8769