=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710744958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUEJOY ADULT FAMILY HOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2024
-----------------------------------------------------
Last Update Date | 03/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7642 S SHERIDAN AVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98408-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-500-4056
-----------------------------------------------------
Fax | 253-235-0127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7642 S SHERIDAN AVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98408-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-500-4056
-----------------------------------------------------
Fax | 253-235-0127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | MOUREEN JEPCHUMBA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-500-4056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------