Provider Demographics
NPI:1376219154
Name:TRUE CARE PRIVATE CARE ENTERPRISE, LLC
Entity Type:Organization
Organization Name:TRUE CARE PRIVATE CARE ENTERPRISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:770-324-6799
Mailing Address - Street 1:8336 OFFICE PARK DR STE H
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6937
Mailing Address - Country:US
Mailing Address - Phone:770-324-6799
Mailing Address - Fax:
Practice Address - Street 1:8336 OFFICE PARK DR STE H
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-6937
Practice Address - Country:US
Practice Address - Phone:770-324-6799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health