Provider Demographics
NPI:1417502584
Name:TRUE BLUE NON MEDICAL PERSONAL CARE ETC
Entity Type:Organization
Organization Name:TRUE BLUE NON MEDICAL PERSONAL CARE ETC
Other - Org Name:TRUE BLUE NON MEDICAL PERSONAL ETC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DECOVAN
Authorized Official - Middle Name:ONEAL
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-980-8159
Mailing Address - Street 1:6633 W AIRPORT BLVD APT 915
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-5281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6633 W AIRPORT BLVD APT 915
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-5281
Practice Address - Country:US
Practice Address - Phone:346-980-8159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No347C00000XTransportation ServicesPrivate Vehicle