Provider Demographics
NPI:1437659091
Name:TREE OF LIFE PRIMARY CARE AND RECOVERY LLC
Entity Type:Organization
Organization Name:TREE OF LIFE PRIMARY CARE AND RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:646-785-7452
Mailing Address - Street 1:129 CHURCH ST STE 417
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2052
Mailing Address - Country:US
Mailing Address - Phone:646-785-7452
Mailing Address - Fax:
Practice Address - Street 1:129 CHURCH ST STE 417
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2052
Practice Address - Country:US
Practice Address - Phone:646-785-7452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health