MEDICARE: TRI-WIL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility		AL
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		AL

General Provider Information

NPI Number	:	1689787665
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-WIL, INC.

Provider Business Mailing Address
First Line	:	PO BOX 77
Second Line	:
City	:	GREEN POND
State	:	AL
Zip	:	35074-0077
Country	:	US
Telephone Number	:	205-938-7855
Fax Number	:	205-938-3647

Provider Business Practice Location Address
First Line	:	65 ENTERPRISE LOOP
Second Line	:
City	:	WOODSTOCK
State	:	AL
Zip	:	35188-4040
Country	:	US
Telephone Number	:	205-938-7855
Fax Number	:	205-938-3647

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES BROWN
Credential	:
Telephone Number	:	205-938-7855

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	03/24/2008

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Directions to “TRI-WIL, INC. ” Practice Location

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