Provider Demographics
NPI:1114754959
Name:A TREE OF LIFE HOME HEALTH CARE CORP
Entity type:Organization
Organization Name:A TREE OF LIFE HOME HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-447-4406
Mailing Address - Street 1:110 E WAYNE ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802
Mailing Address - Country:US
Mailing Address - Phone:317-506-0024
Mailing Address - Fax:
Practice Address - Street 1:110 E WAYNE ST FL 12
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2611
Practice Address - Country:US
Practice Address - Phone:317-506-0024
Practice Address - Fax:317-350-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
No251B00000XAgenciesCase Management
No302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Single Specialty