MEDICARE: TREES OF LIFE, 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	251S00000X	Community/Behavioral Health Agency		NC

General Provider Information

NPI Number	:	1982856902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TREES OF LIFE, LLC

Provider Business Mailing Address
First Line	:	1796 TINKERMILL CT
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8585
Country	:	US
Telephone Number	:	336-988-4738
Fax Number	:	336-455-9175

Provider Business Practice Location Address
First Line	:	2208 SHARPE RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-8503
Country	:	US
Telephone Number	:	336-455-9175
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MELISSA DENISE HAIRSTON
Credential	:
Telephone Number	:	336-988-4738

Provider Enumeration Date	:	10/22/2008
Last Update Date	:	10/22/2008

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