Healthcare Provider Details

I. General information

NPI: 1336272350
Provider Name (Legal Business Name): TANNERHILL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HIGH ST
PASCOAG RI
02859-2620
US

IV. Provider business mailing address

PO BOX 414 35 HIGH STREET
PASCOAG RI
02859-0414
US

V. Phone/Fax

Practice location:
  • Phone: 401-568-3650
  • Fax: 401-568-4207
Mailing address:
  • Phone: 401-568-3650
  • Fax: 401-568-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberT103861
License Number StateRI

VIII. Authorized Official

Name: MR. CLARK LAMBOY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-568-3650