Healthcare Provider Details

I. General information

NPI: 1891621660
Provider Name (Legal Business Name): LGTC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25971 MAR VISTA CT
LOS GATOS CA
95033-8026
US

IV. Provider business mailing address

4850 UNION AVE
SAN JOSE CA
95124-5156
US

V. Phone/Fax

Practice location:
  • Phone: 800-913-2615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: YEVGENIY TILMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 408-505-1873