Provider Demographics
NPI:1245085414
Name:TRUEVINE ADDICTION AND MENTAL HEALTH CLINIC LLC
Entity type:Organization
Organization Name:TRUEVINE ADDICTION AND MENTAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:201-993-3110
Mailing Address - Street 1:121 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3512
Mailing Address - Country:US
Mailing Address - Phone:201-993-3110
Mailing Address - Fax:
Practice Address - Street 1:2294 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4869
Practice Address - Country:US
Practice Address - Phone:201-993-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty