Provider Demographics
NPI:1457971319
Name:TRUE LIFE CARE LLC
Entity Type:Organization
Organization Name:TRUE LIFE CARE LLC
Other - Org Name:TRUE LIFE CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-464-7769
Mailing Address - Street 1:7200 ALOMA AVE STE 2G
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7133
Mailing Address - Country:US
Mailing Address - Phone:954-464-7769
Mailing Address - Fax:321-282-1438
Practice Address - Street 1:7200 ALOMA AVE STE 2G
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7133
Practice Address - Country:US
Practice Address - Phone:954-464-7769
Practice Address - Fax:321-282-1438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043860455Medicaid