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General NPI Number Information
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NPI Number | 1730817701
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Entity Type | Organization
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Legal Business Name | TREE'S OF LIFE HOMECARE LLC
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 517 BRENSTON CT
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City | ELLENWOOD
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State | GA
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Zip | 30294-4903
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Country | US
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Telephone | 770-688-5763
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Fax | 404-343-1071
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Provider Business Mailing Address
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Address Line | 517 BRENSTON CT
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City | ELLENWOOD
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State | GA
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Zip | 30294-4903
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Country | US
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Telephone | 770-688-5763
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Fax | 404-343-1071
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Authorized Official
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Title or Position | ADMINISTATOR
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Name | MRS. WILGENIA LOCHONA STARKS
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Credential | OWN
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Telephone | 770-688-5763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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