Provider Demographics
NPI:1659951036
Name:TRUCARE LLC
Entity Type:Organization
Organization Name:TRUCARE LLC
Other - Org Name:TRUCARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/ WAIVER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-318-3116
Mailing Address - Street 1:2545 PROMENADE WAY APT 210
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2965
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2545 PROMENADE WAY APT 210
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-2965
Practice Address - Country:US
Practice Address - Phone:219-318-3116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-10
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child