Provider Demographics
NPI:1083399794
Name:TRU TRANSFORMATION LLC
Entity Type:Organization
Organization Name:TRU TRANSFORMATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:443-477-0563
Mailing Address - Street 1:4711 LIBERTY HEIGHTS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7155
Mailing Address - Country:US
Mailing Address - Phone:443-477-0563
Mailing Address - Fax:410-665-4960
Practice Address - Street 1:4711 LIBERTY HEIGHTS AVE FL 1
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-7155
Practice Address - Country:US
Practice Address - Phone:443-477-0563
Practice Address - Fax:410-665-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health