Provider Demographics
NPI:1275998700
Name:MENDING FENCES
Entity Type:Organization
Organization Name:MENDING FENCES
Other - Org Name:MENDING FENCES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:TILMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEARS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-528-2801
Mailing Address - Street 1:15530 W HIGHWAY 326
Mailing Address - Street 2:
Mailing Address - City:MORRISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32668-7311
Mailing Address - Country:US
Mailing Address - Phone:352-528-1300
Mailing Address - Fax:352-528-0651
Practice Address - Street 1:15530 W HIGHWAY 326
Practice Address - Street 2:
Practice Address - City:MORRISTON
Practice Address - State:FL
Practice Address - Zip Code:32668-7311
Practice Address - Country:US
Practice Address - Phone:352-528-1300
Practice Address - Fax:352-528-0651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility