Provider Demographics
NPI:1265757579
Name:TREE OF LIFE COMMUNITY PCS
Entity type:Organization
Organization Name:TREE OF LIFE COMMUNITY PCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-832-1108
Mailing Address - Street 1:2315 18TH PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3610
Mailing Address - Country:US
Mailing Address - Phone:202-832-1108
Mailing Address - Fax:202-832-1113
Practice Address - Street 1:2315 18TH PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3610
Practice Address - Country:US
Practice Address - Phone:202-832-1108
Practice Address - Fax:202-832-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)