MEDICARE: TRUSTED LOYAL CAREGIVERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311Z00000X	Custodial Care Facility	2597	AL

General Provider Information

NPI Number	:	1265744965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTED LOYAL CAREGIVERS, LLC

Provider Business Mailing Address
First Line	:	3445 S VALLEY RD
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-8110
Country	:	US
Telephone Number	:	256-442-6485
Fax Number	:

Provider Business Practice Location Address
First Line	:	3445 S VALLEY RD
Second Line	:
City	:	SOUTHSIDE
State	:	AL
Zip	:	35907-8110
Country	:	US
Telephone Number	:	256-442-6485
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. THOMAS D JOHNSON
Credential	:	LCSW
Telephone Number	:	256-442-6485

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	07/09/2010

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