Provider Demographics
NPI:1144832700
Name:TRU GRULZ ENTERPRISES, INC.
Entity type:Organization
Organization Name:TRU GRULZ ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:TIREA
Authorized Official - Last Name:RAVNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-517-6609
Mailing Address - Street 1:PO BOX 11965
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32239-1965
Mailing Address - Country:US
Mailing Address - Phone:800-373-0393
Mailing Address - Fax:
Practice Address - Street 1:7707 MERRILL RD STE 11965
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3714
Practice Address - Country:US
Practice Address - Phone:800-373-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care