Provider Demographics
NPI:1184369191
Name:FAMILY TREE COMMUNITY CARE
Entity type:Organization
Organization Name:FAMILY TREE COMMUNITY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABI
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:972-514-4032
Mailing Address - Street 1:2109 W PARKER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-7739
Mailing Address - Country:US
Mailing Address - Phone:214-230-0054
Mailing Address - Fax:
Practice Address - Street 1:2109 W PARKER RD STE 208
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-7739
Practice Address - Country:US
Practice Address - Phone:214-230-0054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty