MEDICARE: TLC PROVIDERS INC

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417251638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC PROVIDERS INC

Provider Business Mailing Address
First Line	:	8317 FRONT BEACH RD
Second Line	:	SUITE 29A1
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4885
Country	:	US
Telephone Number	:	850-236-0073
Fax Number	:	850-236-0403

Provider Business Practice Location Address
First Line	:	8317 FRONT BEACH RD
Second Line	:	SUITE 29A1
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-4885
Country	:	US
Telephone Number	:	850-236-0073
Fax Number	:	850-236-0403

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. TERRY WAYNE BOOKER
Credential	:
Telephone Number	:	850-236-0073

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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Directions to “TLC PROVIDERS INC ” Practice Location

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