Provider Demographics
NPI:1285019471
Name:TANJER HOUSE
Entity type:Organization
Organization Name:TANJER HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-884-3195
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-1115
Mailing Address - Country:US
Mailing Address - Phone:828-884-3195
Mailing Address - Fax:828-884-3102
Practice Address - Street 1:260 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3022
Practice Address - Country:US
Practice Address - Phone:828-884-2550
Practice Address - Fax:828-884-3102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSYLVANIA VOCATIONAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-29
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL088026320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408915Medicaid