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General NPI Number Information
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NPI Number | 1366823700
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Entity Type | Organization
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Legal Business Name | LIVING TREE COMMUNITY CARE,LLC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 06/11/2015
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Provider Practice Location Address
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Address Line | 500 S AUSTRALIAN AVE STE 600
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6237
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Country | US
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Telephone | 561-236-7799
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Fax |
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Provider Business Mailing Address
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Address Line | 500 S AUSTRALIAN AVE STE 600
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-6237
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | YASMINE DOMINIQUE-MERVEUS
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Credential |
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Telephone | 561-236-7799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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