| Tree Of Life Healing Arts, Llc | |
|
429 W Lasalle Ave Apt 2 South Bend IN 46601-1166 | |
| (574) 520-8444 | |
| (574) 367-2154 |
| Full Name | Tree Of Life Healing Arts, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 429 W Lasalle Ave Apt 2, South Bend, Indiana |
| Authorized Official Name and Position | Tracey Lynn Malesa-wheaton (SINGLE MEMBER LLC OWNER) |
| Authorized Official Contact | 5745208444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tree Of Life Healing Arts, Llc 507 W Lasalle Ave South Bend IN 46601-1108 Ph: (574) 520-8444 | Tree Of Life Healing Arts, Llc 429 W Lasalle Ave Apt 2 South Bend IN 46601-1166 Ph: (574) 520-8444 |
| NPI Number | 1942998273 |
|---|---|
| Provider Enumeration Date | 04/25/2023 |
| Last Update Date | 03/12/2024 |
| Certification Date | 02/18/2024 |
| Medicare PECOS PAC ID | 8224472824 |
|---|---|
| Medicare Enrollment ID | O20240222002322 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942998273 | NPI | - | NPPES |
| Provider Name | Tracey L Malesa Wheaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265861512 PECOS PAC ID: 4981908373 Enrollment ID: I20160204001739 |
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