Provider Demographics
NPI:1649674664
Name:ERICA'S TREE OF LIFE,LLC
Entity type:Organization
Organization Name:ERICA'S TREE OF LIFE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-881-1279
Mailing Address - Street 1:1564 N GALLOWAY AVE
Mailing Address - Street 2:826
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2391
Mailing Address - Country:US
Mailing Address - Phone:214-881-1279
Mailing Address - Fax:
Practice Address - Street 1:1564 N GALLOWAY AVE
Practice Address - Street 2:826
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2391
Practice Address - Country:US
Practice Address - Phone:214-881-1279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care