Provider Demographics
NPI:1407197049
Name:TRUEVINE HEALTHCARE LLC
Entity Type:Organization
Organization Name:TRUEVINE HEALTHCARE LLC
Other - Org Name:MED STAFF HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGINAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNDELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-558-1887
Mailing Address - Street 1:2424 SPRINGER DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3966
Mailing Address - Country:US
Mailing Address - Phone:405-253-4413
Mailing Address - Fax:877-681-8330
Practice Address - Street 1:2424 SPRINGER DR STE 300
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3966
Practice Address - Country:US
Practice Address - Phone:405-253-4413
Practice Address - Fax:877-681-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC8018251E00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health