MEDICARE: THERAPEUTIC ALTERNATIVES AND MEDICAL CANNABIS CENTER LLC

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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1720715543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPEUTIC ALTERNATIVES AND MEDICAL CANNABIS CENTER LLC

Provider Business Mailing Address
First Line	:	3970 POST RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-9235
Country	:	US
Telephone Number	:	401-287-8810
Fax Number	:	401-287-8847

Provider Business Practice Location Address
First Line	:	3970 POST RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-9235
Country	:	US
Telephone Number	:	401-287-8810
Fax Number	:	401-287-8847

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DR. TASIA HENDERSON
Credential	:	DNP
Telephone Number	:	401-287-8810

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	05/28/2024

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