MEDICARE: TREMENDOULAS 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	374J00000X	Doula

General Provider Information

NPI Number	:	1649663709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREMENDOULAS LLC

Provider Business Mailing Address
First Line	:	318 MONROE DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	318 MONROE DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1928
Country	:	US
Telephone Number	:	561-827-3263
Fax Number	:

Authorized Official
Title or Position	:	CEO, OWNER
Name	:	CHRISTINE FRACKELTON
Credential	:
Telephone Number	:	561-827-3263

Provider Enumeration Date	:	03/13/2015
Last Update Date	:	03/13/2015

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Directions to “TREMENDOULAS LLC ” Practice Location

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