MEDICARE: TREE OF LIFE HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	247ZC0005X	Clinical Laboratory Director (Non-physician)
2	310400000X	Assisted Living Facility
3	315P00000X	Intellectual Disabilities Intermediate Care Facility

General Provider Information

NPI Number	:	1285398339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF LIFE HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	621 GRIFFIN ST
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-2329
Country	:	US
Telephone Number	:	214-560-4482
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 GRIFFIN ST
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-2329
Country	:	US
Telephone Number	:	214-560-4482
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHARECKA GRUBBS
Credential	:	RN
Telephone Number	:	214-434-3141

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	08/17/2023

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