Healthcare Provider Details

I. General information

NPI: 1912003591
Provider Name (Legal Business Name): TREE OF LIFE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 WESTERRE PKWY STE B
RICHMOND VA
23233-1332
US

IV. Provider business mailing address

3721 WESTERRE PKWY STE B
RICHMOND VA
23233-1332
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-5484
  • Fax: 804-270-1220
Mailing address:
  • Phone: 804-270-5484
  • Fax: 804-270-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License NumberCLO06286
License Number StateVA

VIII. Authorized Official

Name: DR. NATHAN D ZASLER
Title or Position: CEO
Credential: M.D.
Phone: 804-270-5484