MEDICARE: TRUECARE WELLNESS CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1740139328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUECARE WELLNESS CLINIC LLC

Provider Business Mailing Address
First Line	:	4007 W SAINT CHARLES AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4976
Country	:	US
Telephone Number	:	818-810-8120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4007 W SAINT CHARLES AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-4976
Country	:	US
Telephone Number	:	818-810-8120
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DERRICK SSENKUSU
Credential	:
Telephone Number	:	818-810-8120

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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