Provider Demographics
NPI:1689787665
Name:TRI-WIL, INC.
Entity Type:Organization
Organization Name:TRI-WIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-938-7855
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:GREEN POND
Mailing Address - State:AL
Mailing Address - Zip Code:35074-0077
Mailing Address - Country:US
Mailing Address - Phone:205-938-7855
Mailing Address - Fax:205-938-3647
Practice Address - Street 1:65 ENTERPRISE LOOP
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:AL
Practice Address - Zip Code:35188-4040
Practice Address - Country:US
Practice Address - Phone:205-938-7855
Practice Address - Fax:205-938-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL322D00000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility