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General NPI Number Information
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NPI Number | 1699142356
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE ELDER CARE, INC
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 1308 HACIENDA DR
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City | EL CAJON
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State | CA
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Zip | 92020-1324
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Country | US
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Telephone | 619-913-2666
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Fax | 619-599-8161
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Provider Business Mailing Address
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Address Line | 1308 HACIENDA DR
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City | EL CAJON
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State | CA
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Zip | 92020-1324
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Country | US
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Telephone | 619-913-2666
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Fax | 619-599-8161
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Authorized Official
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Title or Position | CEO
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Name | DR. MONTGOMERY OSTRANDER
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Credential | DD, MSW, MBA
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Telephone | 619-913-2666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 374602652
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License Number State | CA
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