Provider Demographics
NPI:1891193256
Name:TREE OF LIFE ARIZONA LLC
Entity Type:Organization
Organization Name:TREE OF LIFE ARIZONA LLC
Other - Org Name:TREE OF LIFE ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:480-284-6498
Mailing Address - Street 1:1659 E DRAPER CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-6628
Mailing Address - Country:US
Mailing Address - Phone:480-284-6498
Mailing Address - Fax:480-350-7960
Practice Address - Street 1:1659 E DRAPER CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-6628
Practice Address - Country:US
Practice Address - Phone:480-284-6498
Practice Address - Fax:480-350-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4477322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children