Provider Demographics
NPI:1811326655
Name:TREE OF LIFE HEATHCARE, INC.
Entity type:Organization
Organization Name:TREE OF LIFE HEATHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-225-0355
Mailing Address - Street 1:PO BOX 9205
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9205
Mailing Address - Country:US
Mailing Address - Phone:706-225-0355
Mailing Address - Fax:706-225-0360
Practice Address - Street 1:1968 NORTH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1525
Practice Address - Country:US
Practice Address - Phone:706-225-0355
Practice Address - Fax:706-225-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085223261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center