Healthcare Provider Details
I. General information
NPI: 1508463944
Provider Name (Legal Business Name): TRUCARE PROVIDER SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/08/2020
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3600 PARK 42 DR STE 3670
CINCINNATI OH
45241-4049
US
IV. Provider business mailing address
3600 PARK 42 DR STE 3670
CINCINNATI OH
45241-4049
US
V. Phone/Fax
- Phone: 513-201-5708
- Fax: 513-510-4911
- Phone: 513-201-5708
- Fax: 513-510-4911
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 171WH0202X |
| Taxonomy | Home Modifications Contractor |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251C00000X |
| Taxonomy | Developmentally Disabled Services Day Training Agency |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 253Z00000X |
| Taxonomy | In Home Supportive Care Agency |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 261QA0600X |
| Taxonomy | Adult Day Care Clinic/Center |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 333300000X |
| Taxonomy | Emergency Response System Companies |
| License Number | |
| License Number State | |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 343900000X |
| Taxonomy | Non-emergency Medical Transport (VAN) |
| License Number | |
| License Number State | |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 347C00000X |
| Taxonomy | Private Vehicle |
| License Number | |
| License Number State | |
| # 8 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 3747P1801X |
| Taxonomy | Personal Care Attendant |
| License Number | |
| License Number State | |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 374U00000X |
| Taxonomy | Home Health Aide |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
KELLY
LEMUEL
Title or Position: PRESIDENT
Credential:
Phone: 513-201-5708