Healthcare Provider Details

I. General information

NPI: 1629996319
Provider Name (Legal Business Name): TRUE LTC 103 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

187 HOSPITAL DR
TYRONE PA
16686-1808
US

IV. Provider business mailing address

15 TREMBLANT CT
LUTHERVILLE TIMONIUM MD
21093-3747
US

V. Phone/Fax

Practice location:
  • Phone: 443-465-8088
  • Fax:
Mailing address:
  • Phone: 443-465-8088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JILL C FORD
Title or Position: SENIOR DIRECTOR OF OPERATIONS
Credential:
Phone: 484-643-2629