Provider Demographics
NPI:1881917359
Name:ETHEL'S TREE OF LIFE, INC.
Entity type:Organization
Organization Name:ETHEL'S TREE OF LIFE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-438-9449
Mailing Address - Street 1:115 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:KITTERY POINT
Mailing Address - State:ME
Mailing Address - Zip Code:03905-5650
Mailing Address - Country:US
Mailing Address - Phone:207-438-9449
Mailing Address - Fax:207-438-9449
Practice Address - Street 1:518 RTE 1
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-438-9449
Practice Address - Fax:207-438-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service