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NPI Code Detail

MEDICARE: TREE OF LIFE PROFESSIONAL BEHAVORIAL HEALTH SERVICES

MEDICARE: TREE OF LIFE PROFESSIONAL BEHAVORIAL HEALTH SERVICES
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
1261QM0855XAdolescent and Children Mental Health Clinic/Center132210PA
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)132210PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639299167
Entity Type Code : Organization
Provider Name (Legal Business Name) : TREE OF LIFE PROFESSIONAL BEHAVORIAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 7048 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-1713
Country : US
Telephone Number : 215-533-5433
Fax Number : 215-533-5432
Provider Business Practice Location Address
First Line : 7048 CASTOR AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19149-1713
Country : US
Telephone Number : 215-533-5433
Fax Number : 215-533-5432
Authorized Official
Title or Position : CEO
Name : MS. ADA L TULEJA
Credential : MSW
Telephone Number : 215-533-5433
Provider Enumeration Date : 03/29/2007
Last Update Date : 01/28/2009

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Directions to “TREE OF LIFE PROFESSIONAL BEHAVORIAL HEALTH SERVICES ” Practice Location

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