Provider Demographics
NPI:1093304966
Name:TREE OF LIFE HEALTH ENTERPRISE, LLC
Entity Type:Organization
Organization Name:TREE OF LIFE HEALTH ENTERPRISE, LLC
Other - Org Name:TREE OF LIFE HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:468-699-8227
Mailing Address - Street 1:7515 GREENVILLE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3819
Mailing Address - Country:US
Mailing Address - Phone:469-699-8227
Mailing Address - Fax:772-571-4956
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3831
Practice Address - Country:US
Practice Address - Phone:469-699-8227
Practice Address - Fax:772-571-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000OtherNONE