Provider Demographics
NPI:1558927590
Name:TALL FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:TALL FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:TALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-975-6118
Mailing Address - Street 1:6021 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-8212
Mailing Address - Country:US
Mailing Address - Phone:704-975-6118
Mailing Address - Fax:
Practice Address - Street 1:1915 HASTY RD
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-0029
Practice Address - Country:US
Practice Address - Phone:704-624-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility