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General NPI Number Information
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NPI Number | 1760965735
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Entity Type | Organization
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Legal Business Name | TILLMAN RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 4009 SHILLINGFORD DR
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City | RICHMOND
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State | VA
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Zip | 23223-4928
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Country | US
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Telephone | 804-439-3184
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Fax | 804-226-4201
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Provider Business Mailing Address
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Address Line | 4009 SHILLINGFORD DR
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City | RICHMOND
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State | VA
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Zip | 23223-4928
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Country | US
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Telephone | 804-439-3184
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Fax | 804-226-4201
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Authorized Official
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Title or Position | OWNER
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Name | ALVIN TILLMAN
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Credential |
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Telephone | 804-439-3184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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