TL Bearwallow LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

TL BEARWALLOW LLC

Doing business as

The Lodge at Bearwallow

Practice address

42 Heros Way
Hendersonville, NC 28792

Phone

(877) 279-8972

NPI assigned

Feb 26, 2024

Last updated

Feb 26, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brett McGennis

Title

Coo

Phone

(412) 742-7546

Specialties & licenses 3

Addresses

Other names 1

• The Lodge at Bearwallow Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1225894470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 HEROS WAY",
            "city": "HENDERSONVILLE",
            "state": "NC",
            "postal_code": "287920145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 HEROS WAY",
            "city": "HENDERSONVILLE",
            "state": "NC",
            "postal_code": "28792",
            "telephone_number": "877-279-8972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TL BEARWALLOW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "MCGENNIS",
        "authorized_official_first_name": "BRETT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "412-742-7546"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Lodge at Bearwallow",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samuel Grey Tilden, MD
• Aimee Nicole Tillman, PT
• Aaron Michael Timins, D.O
• Timothy P. Anderson, O.D., P.a.
• Joel Steven Tipton, CEP
• Ethan Hurley Tobin, PA
• Elizabeth Drysdale Todd, OD
• Juelena Renee Lalone Todd, M.D.
• Martha Todd, F-NP
• Richard Bennett Todd Jr., DDS

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Hendersonville, NC
• Providers in Hendersonville, NC by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.