Healthcare Provider Details

I. General information

NPI: 1114754959
Provider Name (Legal Business Name): A TREE OF LIFE HOME HEALTH CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E WAYNE ST FL 12
FORT WAYNE IN
46802-2611
US

IV. Provider business mailing address

110 E WAYNE ST 12TH FLOOR
FORT WAYNE IN
46802
US

V. Phone/Fax

Practice location:
  • Phone: 317-506-0024
  • Fax: 317-350-0043
Mailing address:
  • Phone: 317-506-0024
  • 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 Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MALINDA BUTLER
Title or Position: MANAGER
Credential: NP
Phone: 317-447-4406