Healthcare Provider Details

I. General information

NPI: 1659831741
Provider Name (Legal Business Name): TRUNIC CLASSIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 03/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23223 SANDPIPER TRL
SPRING TX
77373-7468
US

IV. Provider business mailing address

23223 SANDPIPER TRL
SPRING TX
77373-7468
US

V. Phone/Fax

Practice location:
  • Phone: 281-610-1997
  • Fax:
Mailing address:
  • Phone: 281-610-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: GERTRUDE CHINWE MADUEKE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 281-610-1997