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General NPI Number Information
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NPI Number | 1366267304
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Entity Type | Organization
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Legal Business Name | LIFE TREE CARE CENTER INC
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 11240 WAPLES MILL RD STE 201
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City | FAIRFAX
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State | VA
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Zip | 22030-6078
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Country | US
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Telephone | 434-212-0460
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Fax | 703-570-7668
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Provider Business Mailing Address
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Address Line | 11240 WAPLES MILL RD STE 201
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City | FAIRFAX
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State | VA
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Zip | 22030-6078
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Country | US
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Telephone | 434-212-0460
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Fax | 703-570-7668
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Authorized Official
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Title or Position | PRESIDENT
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Name | KYONG HOON KO
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Credential | PMP
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Telephone | 434-212-0460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #6
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #7
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | NULL
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Taxonomy #8
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | NULL
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Taxonomy #9
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State | NULL
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Taxonomy #10
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | NULL
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Taxonomy #11
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | NULL
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Taxonomy #12
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | NULL
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Taxonomy #13
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State | NULL
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Taxonomy #14
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #15
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | NULL
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