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General NPI Number Information
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NPI Number | 1669715454
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Entity Type | Organization
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Legal Business Name | TANNER/ZAREMBA CONST CO., INC
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 1207 SPOTSWOOD DR
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City | LOCUST GROVE
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State | VA
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Zip | 22508-2139
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Country | US
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Telephone | 540-423-1055
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 SPOTSWOOD DR
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City | LOCUST GROVE
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State | VA
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Zip | 22508-2139
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Country | US
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Telephone | 540-423-1055
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GLENN TANNER
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Credential | BUILDING CONTRACTOR
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Telephone | 540-423-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 2701022436
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License Number State | VA
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