Provider Demographics
NPI:1700429628
Name:TREE OF LIFE INCORPORATED
Entity Type:Organization
Organization Name:TREE OF LIFE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:TARA
Authorized Official - Last Name:HUGHLEY GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-333-8728
Mailing Address - Street 1:PO BOX 3304
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-0067
Mailing Address - Country:US
Mailing Address - Phone:706-333-8728
Mailing Address - Fax:
Practice Address - Street 1:2451 W POINT RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3909
Practice Address - Country:US
Practice Address - Phone:706-333-8728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management