Provider Demographics
NPI:1134269913
Name:BUFFALO RIVER SERVICES, INC.
Entity type:Organization
Organization Name:BUFFALO RIVER SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-722-5401
Mailing Address - Street 1:410 HOG CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-3704
Mailing Address - Country:US
Mailing Address - Phone:931-722-5401
Mailing Address - Fax:931-722-5403
Practice Address - Street 1:410 HOG CREEK RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-3704
Practice Address - Country:US
Practice Address - Phone:931-722-5401
Practice Address - Fax:931-722-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3(20)4M5-046-3258251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services