Provider Demographics
NPI:1659831741
Name:TRUNIC CLASSIC CARE LLC
Entity Type:Organization
Organization Name:TRUNIC CLASSIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:CHINWE
Authorized Official - Last Name:MADUEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-610-1997
Mailing Address - Street 1:23223 SANDPIPER TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-7468
Mailing Address - Country:US
Mailing Address - Phone:281-610-1997
Mailing Address - Fax:
Practice Address - Street 1:23223 SANDPIPER TRL
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-7468
Practice Address - Country:US
Practice Address - Phone:281-610-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities