MEDICARE: TREE OF LIFE PREMIER SERVICES LLC.

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1164297503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREE OF LIFE PREMIER SERVICES LLC.

Provider Business Mailing Address
First Line	:	7570 S FEDERAL HWY STE 8
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-6060
Country	:	US
Telephone Number	:	561-485-7634
Fax Number	:

Provider Business Practice Location Address
First Line	:	7570 S FEDERAL HWY STE 8
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-6060
Country	:	US
Telephone Number	:	561-485-7634
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATOR
Name	:	AGNOLITE FLORIAL
Credential	:	APRN, FNP-BC
Telephone Number	:	561-577-8182

Provider Enumeration Date	:	11/15/2023
Last Update Date	:	11/15/2023

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