Provider Demographics
NPI:1922436815
Name:TRULIFE THERAPY SERVICES
Entity Type:Organization
Organization Name:TRULIFE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEKWESILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-298-3431
Mailing Address - Street 1:1502 WOODLAWN DR STE 103
Mailing Address - Street 2:
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4022
Mailing Address - Country:US
Mailing Address - Phone:410-298-3431
Mailing Address - Fax:
Practice Address - Street 1:1502 WOODLAWN DR STE 103
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4022
Practice Address - Country:US
Practice Address - Phone:410-298-3431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3315251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health