Provider Demographics
NPI:1265947550
Name:TREE OF LIFE FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:TREE OF LIFE FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:347-466-1587
Mailing Address - Street 1:42273 CANARY GRASS SQ
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5706
Mailing Address - Country:US
Mailing Address - Phone:703-798-0767
Mailing Address - Fax:
Practice Address - Street 1:42273 CANARY GRASS SQ
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5706
Practice Address - Country:US
Practice Address - Phone:703-798-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE6633310251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health