Healthcare Provider Details

I. General information

NPI: 1669862793
Provider Name (Legal Business Name): TLC HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E TUDOR RD STE 200
ANCHORAGE AK
99503-7377
US

IV. Provider business mailing address

500 E TUDOR RD STE 200
ANCHORAGE AK
99503-7377
US

V. Phone/Fax

Practice location:
  • Phone: 907-602-5811
  • Fax:
Mailing address:
  • Phone: 907-602-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number1015887
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1015887
License Number StateAK

VIII. Authorized Official

Name: ROSALINA MAVAEGA
Title or Position: PRESIDENT
Credential:
Phone: 907-602-5811