=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588717151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRU-CARE HOME HEALTH, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2007
-----------------------------------------------------
Last Update Date | 03/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9933 LAWLER AVE STE 346
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-3783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-329-0066
-----------------------------------------------------
Fax | 847-915-6548
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9933 LAWLER AVE STE 346
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60077-3783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-329-0066
-----------------------------------------------------
Fax | 847-915-6548
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DOMERLIN SODUSTA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 847-329-0066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010642
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------