Healthcare Provider Details

I. General information

NPI: 1639067556
Provider Name (Legal Business Name): FAMILY TREE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 MARSHALL ST
WHEAT RIDGE CO
80033-5069
US

IV. Provider business mailing address

3805 MARSHALL ST
WHEAT RIDGE CO
80033-5069
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-2133
  • Fax: 303-422-4928
Mailing address:
  • Phone: 303-422-2133
  • Fax: 303-422-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANELE LYONS
Title or Position: CFO
Credential:
Phone: 303-422-2133