Provider Demographics
NPI:1053195164
Name:TRU3 LIGHT CENTER
Entity type:Organization
Organization Name:TRU3 LIGHT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEISAY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:980-210-6520
Mailing Address - Street 1:206 W SECOND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4088
Mailing Address - Country:US
Mailing Address - Phone:980-210-6520
Mailing Address - Fax:
Practice Address - Street 1:206 W SECOND AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4088
Practice Address - Country:US
Practice Address - Phone:980-210-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty