Provider Demographics
NPI:1326828021
Name:TRULY ACTIV SENIOR CARE LLC
Entity Type:Organization
Organization Name:TRULY ACTIV SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-685-9309
Mailing Address - Street 1:2451 N MCMULLEN BOOTH RD STE 247
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1370
Mailing Address - Country:US
Mailing Address - Phone:727-685-9309
Mailing Address - Fax:
Practice Address - Street 1:2451 N MCMULLEN BOOTH RD STE 247
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1370
Practice Address - Country:US
Practice Address - Phone:727-685-9309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care