Provider Demographics
NPI:1568733129
Name:TRUE VINE HEALTHCARE SERVICES INC.
Entity Type:Organization
Organization Name:TRUE VINE HEALTHCARE SERVICES INC.
Other - Org Name:CJ PRIMARY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISELOWO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-375-2323
Mailing Address - Street 1:1111 W ARKANSAS LN STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6376
Mailing Address - Country:US
Mailing Address - Phone:214-375-2323
Mailing Address - Fax:214-375-2411
Practice Address - Street 1:1111 W ARKANSAS LN STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6376
Practice Address - Country:US
Practice Address - Phone:214-375-2323
Practice Address - Fax:214-375-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010401251E00000X
251E00000X, 3747A0650X, 3747P1801X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014784Medicaid