Provider Demographics
NPI:1316982127
Name:TRU-CARE MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:TRU-CARE MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-209-6971
Mailing Address - Street 1:1559 S NOVATO BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4141
Mailing Address - Country:US
Mailing Address - Phone:415-209-6971
Mailing Address - Fax:415-209-6974
Practice Address - Street 1:1559 S NOVATO BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4141
Practice Address - Country:US
Practice Address - Phone:415-209-6971
Practice Address - Fax:415-209-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52474332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03311FMedicaid
CA5536830001Medicare NSC