Provider Demographics
NPI:1952701112
Name:TEARS TEENS EMPOWERMENT AWARENESS WITH RESOLUTIONS, INC.
Entity Type:Organization
Organization Name:TEARS TEENS EMPOWERMENT AWARENESS WITH RESOLUTIONS, INC.
Other - Org Name:BRIDGES GIRLS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CPM, CAADP
Authorized Official - Phone:334-291-6363
Mailing Address - Street 1:1011 S RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-6220
Mailing Address - Country:US
Mailing Address - Phone:334-291-6363
Mailing Address - Fax:334-291-6399
Practice Address - Street 1:206 E OAK ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-1819
Practice Address - Country:US
Practice Address - Phone:334-226-1255
Practice Address - Fax:334-727-1643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32025061322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106867Medicaid
AL1801045117OtherNPI NUMBER FOR TEARS TEENS EMPOWERMENT AWARENESS WITH RESOLUTIONS, INC.