Provider Demographics
NPI:1831830231
Name:TRUE VINE HEALTH SYSTEMS INC.
Entity type:Organization
Organization Name:TRUE VINE HEALTH SYSTEMS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNKIYESI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP-PMH
Authorized Official - Phone:443-469-9528
Mailing Address - Street 1:6239 SETON HILLS LN
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6098
Mailing Address - Country:US
Mailing Address - Phone:443-469-9528
Mailing Address - Fax:
Practice Address - Street 1:6239 SETON HILLS LN
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-6098
Practice Address - Country:US
Practice Address - Phone:443-469-9528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty