Provider Demographics
NPI:1023413549
Name:A TRUE LIFE SOMERSET,LLC
Entity type:Organization
Organization Name:A TRUE LIFE SOMERSET,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-967-5559
Mailing Address - Street 1:100 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4109
Mailing Address - Country:US
Mailing Address - Phone:606-346-0509
Mailing Address - Fax:888-261-3082
Practice Address - Street 1:100 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4109
Practice Address - Country:US
Practice Address - Phone:606-346-0509
Practice Address - Fax:888-261-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health