Provider Demographics
NPI:1164297503
Name:TREE OF LIFE PREMIER SERVICES LLC.
Entity Type:Organization
Organization Name:TREE OF LIFE PREMIER SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AGNOLITE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORIAL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:561-577-8182
Mailing Address - Street 1:7570 S FEDERAL HWY STE 8
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6060
Mailing Address - Country:US
Mailing Address - Phone:561-485-7634
Mailing Address - Fax:
Practice Address - Street 1:7570 S FEDERAL HWY STE 8
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-6060
Practice Address - Country:US
Practice Address - Phone:561-485-7634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care