Healthcare Provider Details

I. General information

NPI: 1639866601
Provider Name (Legal Business Name): TLT CARE ENTERPRISE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 04/20/2023
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9249 DALBERG ST
BELLFLOWER CA
90706-2120
US

IV. Provider business mailing address

9249 DALBERG ST
BELLFLOWER CA
90706-2120
US

V. Phone/Fax

Practice location:
  • Phone: 310-365-1357
  • Fax: 562-239-2479
Mailing address:
  • Phone: 310-365-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: LIZA TRICE
Title or Position: CFO
Credential:
Phone: 562-633-1285