Provider Demographics
NPI:1114446531
Name:TRUE VINE ADULT MEDICAL DAY CARE, LLC.
Entity Type:Organization
Organization Name:TRUE VINE ADULT MEDICAL DAY CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-444-0204
Mailing Address - Street 1:5629 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2272
Mailing Address - Country:US
Mailing Address - Phone:410-444-0204
Mailing Address - Fax:410-444-0124
Practice Address - Street 1:5629 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2272
Practice Address - Country:US
Practice Address - Phone:410-444-0204
Practice Address - Fax:410-444-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health