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General NPI Number Information
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NPI Number | 1114754959
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Entity Type | Organization
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Legal Business Name | A TREE OF LIFE HOME HEALTH CARE CORP
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Dates
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Enumeration Date | 09/16/2024
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 110 E WAYNE ST FL 12
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City | FORT WAYNE
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State | IN
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Zip | 46802-2611
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Country | US
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Telephone | 317-506-0024
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Fax | 317-350-0043
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Provider Business Mailing Address
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Address Line | 110 E WAYNE ST 12TH FLOOR
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City | FORT WAYNE
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State | IN
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Zip | 46802
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Country | US
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Telephone | 317-506-0024
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MALINDA BUTLER
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Credential | NP
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Telephone | 317-447-4406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 364SH0200X
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Taxonomy Name | Home Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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