Provider Demographics
NPI:1962991687
Name:TREE OF LIFE FAMILY BIRTH CENTER
Entity type:Organization
Organization Name:TREE OF LIFE FAMILY BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:QUINKERT
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:812-920-1580
Mailing Address - Street 1:301 GORDON GUTMANN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3766
Mailing Address - Country:US
Mailing Address - Phone:812-282-6114
Mailing Address - Fax:
Practice Address - Street 1:1214 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3704
Practice Address - Country:US
Practice Address - Phone:812-920-1580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200201490AMedicaid