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NPI Code Detail

MEDICARE: LIVING TREE COMMUNITY CARE,LLC

MEDICARE: LIVING TREE COMMUNITY CARE,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
1251B00000XCase Management Agency
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1366823700
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVING TREE COMMUNITY CARE,LLC
Provider Business Mailing Address
First Line : 500 S AUSTRALIAN AVE STE 600
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-6237
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 S AUSTRALIAN AVE STE 600
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33401-6237
Country : US
Telephone Number : 561-236-7799
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : YASMINE DOMINIQUE-MERVEUS
Credential :
Telephone Number : 561-236-7799
Provider Enumeration Date : 06/11/2015
Last Update Date : 06/11/2015

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Directions to “LIVING TREE COMMUNITY CARE,LLC ” Practice Location

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