Provider Demographics
NPI:1760965735
Name:TILLMAN RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:TILLMAN RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-439-3184
Mailing Address - Street 1:4009 SHILLINGFORD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-4928
Mailing Address - Country:US
Mailing Address - Phone:804-439-3184
Mailing Address - Fax:804-226-4201
Practice Address - Street 1:4009 SHILLINGFORD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4928
Practice Address - Country:US
Practice Address - Phone:804-439-3184
Practice Address - Fax:804-226-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services