Provider Demographics
NPI:1750121091
Name:TRULOVECOMMUNITYCENTER
Entity type:Organization
Organization Name:TRULOVECOMMUNITYCENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLESTER
Authorized Official - Middle Name:VERA
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING/CODING
Authorized Official - Phone:775-745-8276
Mailing Address - Street 1:50 W BROADWAY STE 333
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2027
Mailing Address - Country:US
Mailing Address - Phone:775-745-8276
Mailing Address - Fax:
Practice Address - Street 1:6617 S 57TH AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2255
Practice Address - Country:US
Practice Address - Phone:775-745-8276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No347C00000XTransportation ServicesPrivate Vehicle