Provider Demographics
NPI:1366109704
Name:THE GATHERING INN
Entity type:Organization
Organization Name:THE GATHERING INN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-791-9355
Mailing Address - Street 1:201 BERKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2205
Mailing Address - Country:US
Mailing Address - Phone:916-791-9355
Mailing Address - Fax:
Practice Address - Street 1:201 BERKELEY AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2205
Practice Address - Country:US
Practice Address - Phone:916-791-9355
Practice Address - Fax:916-791-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management