Provider Demographics
NPI:1629647243
Name:TRUECARE WELLNESS GROUP INC
Entity Type:Organization
Organization Name:TRUECARE WELLNESS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEYVA ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-339-6717
Mailing Address - Street 1:7270 NW 12TH ST STE 840
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7270 NW 12TH ST STE 840
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1951
Practice Address - Country:US
Practice Address - Phone:832-339-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUECARE WELLNESS GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104860201Medicaid