MEDICARE: TRUE VINE HEALTH SYSTEMS INC.

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)
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1831830231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUE VINE HEALTH SYSTEMS INC.

Provider Business Mailing Address
First Line	:	6108 LIBERTY RD STE A3
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-6207
Country	:	US
Telephone Number	:	443-469-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	6108 LIBERTY RD STE A3
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-6207
Country	:	US
Telephone Number	:	443-469-9528
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BOLA OSUNKIYESI
Credential	:
Telephone Number	:	985-464-9810

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	01/16/2026

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