Provider Demographics
NPI:1407201965
Name:TRULIGHT YOUTH DEVELOPMENT ENTERPRISE LLC
Entity Type:Organization
Organization Name:TRULIGHT YOUTH DEVELOPMENT ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:PISANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-672-3600
Mailing Address - Street 1:4 WHITE OAK CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3046
Mailing Address - Country:US
Mailing Address - Phone:732-672-3600
Mailing Address - Fax:
Practice Address - Street 1:4 WHITE OAK CT
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3046
Practice Address - Country:US
Practice Address - Phone:732-672-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health