Provider Demographics
NPI:1285398339
Name:TREE OF LIFE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:TREE OF LIFE HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARECKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-434-3141
Mailing Address - Street 1:621 GRIFFIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-2329
Mailing Address - Country:US
Mailing Address - Phone:214-560-4482
Mailing Address - Fax:
Practice Address - Street 1:621 GRIFFIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-2329
Practice Address - Country:US
Practice Address - Phone:214-560-4482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility