MEDICARE: AMEHAN TLC HOME 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1972249357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEHAN TLC HOME LLC

Provider Business Mailing Address
First Line	:	16244 S MILITARY TRL STE 740
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6532
Country	:	US
Telephone Number	:	561-843-1722
Fax Number	:

Provider Business Practice Location Address
First Line	:	5170 SAINT JOHN AVE S
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-1112
Country	:	US
Telephone Number	:	561-843-1722
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. AMANDA HANVIVATPONG
Credential	:
Telephone Number	:	561-843-1722

Provider Enumeration Date	:	05/09/2022
Last Update Date	:	05/10/2022

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