Provider Demographics
NPI:1285104000
Name:TRUENORTH WELLNESS SERVICES
Entity type:Organization
Organization Name:TRUENORTH WELLNESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-632-4900
Mailing Address - Street 1:625 W ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5125
Mailing Address - Country:US
Mailing Address - Phone:717-632-4900
Mailing Address - Fax:717-632-3657
Practice Address - Street 1:119 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-1302
Practice Address - Country:US
Practice Address - Phone:717-485-3264
Practice Address - Fax:717-485-3467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA334580Medicaid