MEDICARE: FAMILY TREE RELIEF NURSERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency		OR

General Provider Information

NPI Number	:	1104375468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY TREE RELIEF NURSERY

Provider Business Mailing Address
First Line	:	PO BOX 844
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-0305
Country	:	US
Telephone Number	:	541-967-6580
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 NW SPRINGHILL DR
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-1748
Country	:	US
Telephone Number	:	541-967-6580
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. RENEE SMITH
Credential	:
Telephone Number	:	541-967-6580

Provider Enumeration Date	:	09/28/2016
Last Update Date	:	09/28/2016

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