Provider Demographics
NPI:1164119442
Name:TRUE VINE HEALTH LLC
Entity Type:Organization
Organization Name:TRUE VINE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-600-9450
Mailing Address - Street 1:5629 HARFORD RD STE 102
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:667-600-9450
Mailing Address - Fax:
Practice Address - Street 1:5629 HARFORD RD STE 102
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:667-600-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUE VINE HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health