Provider Demographics
NPI:1053905927
Name:TREE OF LIFE OUTREACH OF TN
Entity type:Organization
Organization Name:TREE OF LIFE OUTREACH OF TN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-983-1707
Mailing Address - Street 1:434 MONTICELLO ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-4300
Mailing Address - Country:US
Mailing Address - Phone:615-983-1707
Mailing Address - Fax:
Practice Address - Street 1:1276 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4418
Practice Address - Country:US
Practice Address - Phone:615-983-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory