Provider Demographics
NPI:1144740572
Name:TREE OF LIFE ARIZONA LLC
Entity Type:Organization
Organization Name:TREE OF LIFE ARIZONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-241-9963
Mailing Address - Street 1:PO BOX 2367
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85214-2367
Mailing Address - Country:US
Mailing Address - Phone:480-284-6498
Mailing Address - Fax:480-350-7960
Practice Address - Street 1:2935 E DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-6907
Practice Address - Country:US
Practice Address - Phone:480-241-9963
Practice Address - Fax:480-350-7960
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TREE OF LIFE ARIZONA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5139322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children