Provider Demographics
NPI:1407387905
Name:TREE OF LIFE IN-HOME CARE & SVCS
Entity Type:Organization
Organization Name:TREE OF LIFE IN-HOME CARE & SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-622-3926
Mailing Address - Street 1:11 OBERON PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5313
Mailing Address - Country:US
Mailing Address - Phone:803-622-3926
Mailing Address - Fax:803-419-8470
Practice Address - Street 1:11 OBERON PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5313
Practice Address - Country:US
Practice Address - Phone:803-622-3926
Practice Address - Fax:803-419-8470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-25
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4701446253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care