Provider Demographics
NPI:1508211624
Name:TRUE BLUE LLC
Entity Type:Organization
Organization Name:TRUE BLUE LLC
Other - Org Name:TRUBLUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY Y
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:BLUEFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMT
Authorized Official - Phone:907-306-0333
Mailing Address - Street 1:751 E 36TH AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4166
Mailing Address - Country:US
Mailing Address - Phone:907-306-0333
Mailing Address - Fax:
Practice Address - Street 1:751 E 36TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4166
Practice Address - Country:US
Practice Address - Phone:907-306-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1031388225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty