Healthcare Provider Details

I. General information

NPI: 1972002269
Provider Name (Legal Business Name): TREE OF LIFE SPECIAL NEEDS ADULT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 C 13TH STREET
SAINT CLOUD FL
34769
US

IV. Provider business mailing address

3912 PORT SEA PL
KISSIMMEE FL
34746-1808
US

V. Phone/Fax

Practice location:
  • Phone: 407-421-1812
  • Fax:
Mailing address:
  • Phone: 407-421-1812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARIA V GARCIA
Title or Position: PRESIDENT
Credential: P.T.
Phone: 407-791-0892