Provider Demographics
NPI:1790326510
Name:TREE OF LIFE WELLNESS PLC
Entity Type:Organization
Organization Name:TREE OF LIFE WELLNESS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BAHROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-890-1158
Mailing Address - Street 1:3672 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST STE 230
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2273
Practice Address - Country:US
Practice Address - Phone:734-890-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care