# THE LIVING TREE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205604733
- **Authorized official:** CHARLENE E COSTA OTR/L (OWNER/PRESIDENT)
- **Authorized official phone:** (978) 906-1254

## Contact information

- **Practice address:** 2270 MAIN ST, ATHOL, MA 01331
- **Practice address phone:** (978) 906-1254
- **Mailing address:** 58 NORTHERN AVE, ATHOL, MA 01331
- **Mailing address phone:** (978) 906-1254

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/14/2023
- **Last updated:** 12/14/2023