Healthcare Provider Details

I. General information

NPI: 1861894032
Provider Name (Legal Business Name): TREE OF LIFE ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 COMMERCIAL ST
FREEPORT NY
11520-2880
US

IV. Provider business mailing address

112 COMMERCIAL ST
FREEPORT NY
11520-2880
US

V. Phone/Fax

Practice location:
  • Phone: 516-442-7247
  • Fax: 516-977-4884
Mailing address:
  • Phone: 516-442-7245
  • Fax: 516-977-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KONSTANTIN KHAIMOV
Title or Position: VP
Credential:
Phone: 516-442-7247