Healthcare Provider Details

I. General information

NPI: 1215063375
Provider Name (Legal Business Name): TEACHING LIVING CONCEPTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8470 LARCH AVE
COTATI CA
94931-4419
US

IV. Provider business mailing address

840 MARK WEST SPRINGS RD
SANTA ROSA CA
95404-1140
US

V. Phone/Fax

Practice location:
  • Phone: 707-664-1356
  • Fax: 707-664-1356
Mailing address:
  • Phone: 707-571-1858
  • Fax: 707-571-1858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. VELVET PEREZ
Title or Position: PRESIDENT CEO
Credential:
Phone: 707-526-5915