Provider Demographics
NPI:1982296182
Name:TRI STATE CENTER FOR AUTISM NURSING AND RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:TRI STATE CENTER FOR AUTISM NURSING AND RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-602-9059
Mailing Address - Street 1:3756 SILVER QUEEN CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7244
Mailing Address - Country:US
Mailing Address - Phone:513-602-9059
Mailing Address - Fax:
Practice Address - Street 1:3756 SILVER QUEEN CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7244
Practice Address - Country:US
Practice Address - Phone:513-602-9059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities