Healthcare Provider Details

I. General information

NPI: 1386551653
Provider Name (Legal Business Name): 100 TRUE LIFE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 MAIN ST APT 3A
PATERSON NJ
07503-1834
US

IV. Provider business mailing address

1076 MAIN ST APT 3A
PATERSON NJ
07503-1834
US

V. Phone/Fax

Practice location:
  • Phone: 862-297-1702
  • Fax:
Mailing address:
  • Phone: 862-297-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN A SAMS I
Title or Position: MANAGING MEMBER
Credential:
Phone: 862-297-1702