Healthcare Provider Details

I. General information

NPI: 1649674664
Provider Name (Legal Business Name): ERICA'S TREE OF LIFE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 N GALLOWAY AVE 826
MESQUITE TX
75149-2391
US

IV. Provider business mailing address

1564 N GALLOWAY AVE 826
MESQUITE TX
75149-2391
US

V. Phone/Fax

Practice location:
  • Phone: 214-881-1279
  • Fax:
Mailing address:
  • Phone: 214-881-1279
  • Fax:

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: MRS. ERICA R SMITH
Title or Position: OWNER
Credential:
Phone: 214-881-1279