MEDICARE: TREE OF LIFE TRANSPORTATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	343800000X	Secured Medical Transport (VAN)
4	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
5	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1093253478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF LIFE TRANSPORTATION

Provider Business Mailing Address
First Line	:	5067 RAINMAKER DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2299
Country	:	US
Telephone Number	:	919-973-6947
Fax Number	:

Provider Business Practice Location Address
First Line	:	5067 RAINMAKER DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-2299
Country	:	US
Telephone Number	:	919-973-6947
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DUAN EVERETT
Credential	:
Telephone Number	:	919-673-6947

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	02/06/2017

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Directions to “TREE OF LIFE TRANSPORTATION ” Practice Location

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