Provider Demographics
NPI:1154919405
Name:A TRUCARE RESIDENTIAL SERVICES LLC
Entity type:Organization
Organization Name:A TRUCARE RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIFATAH
Authorized Official - Middle Name:YUSUF
Authorized Official - Last Name:WARSAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-275-7602
Mailing Address - Street 1:14023 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-6405
Mailing Address - Country:US
Mailing Address - Phone:612-275-7602
Mailing Address - Fax:952-674-4401
Practice Address - Street 1:14023 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-6405
Practice Address - Country:US
Practice Address - Phone:612-275-7602
Practice Address - Fax:952-674-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency