Life Tree Care Center Inc

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

LIFE TREE CARE CENTER INC

Doing business as

Life Tree Adult Day Care
Life Tree Assisted Living
Life Tree Home Care4 more in Other names

Practice address

11240 Waples Mill Rd Ste 201
Fairfax, VA 22030-6078

Phone

(434) 212-0460

Fax

(703) 570-7668

NPI assigned

Nov 15, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyong Hoon Ko, PMP

Title

President

Phone

(434) 212-0460

Specialties & licenses 15

Addresses

Other names 7

• Life Tree Adult Day Care Doing business as
• Life Tree Assisted Living Doing business as
• Life Tree Home Care Doing business as
• Life Tree Nursing Home & Rehabilitation Doing business as
• Life Tree Palliative Care Doing business as
• Life Tree Urgent Care Doing business as
• Life Tree Wellness Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1731628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1366267304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11240 WAPLES MILL RD STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306078",
            "telephone_number": "434-212-0460",
            "fax_number": "703-570-7668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11240 WAPLES MILL RD STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306078",
            "telephone_number": "434-212-0460",
            "fax_number": "703-570-7668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE TREE CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-15",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "KO",
        "authorized_official_first_name": "KYONG",
        "authorized_official_middle_name": "HOON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "434-212-0460",
        "authorized_official_credential": "PMP"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Tree Adult Day Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Tree Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Tree Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Tree Nursing Home & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Tree Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Tree Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Life Tree Wellness Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dianne Victoria Liga, RPA-C

• Adult Day Care Clinic/Center in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Adult Day Care Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.