Provider Demographics
NPI:1164138061
Name:FAMILY TREE AGENCY LLC
Entity Type:Organization
Organization Name:FAMILY TREE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:KAWANZA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-295-1803
Mailing Address - Street 1:3022 GUAVA ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916
Mailing Address - Country:US
Mailing Address - Phone:239-295-1803
Mailing Address - Fax:
Practice Address - Street 1:3022 GUAVA ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916
Practice Address - Country:US
Practice Address - Phone:239-295-1803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health