Healthcare Provider Details

I. General information

NPI: 1710058441
Provider Name (Legal Business Name): TLC OF THE BAY AREA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 CLYDE AVENUE
SANTA CLARA CA
95054
US

IV. Provider business mailing address

991 CLYDE AVENUE
SANTA CLARA CA
95054
US

V. Phone/Fax

Practice location:
  • Phone: 408-988-7667
  • Fax: 408-988-2867
Mailing address:
  • Phone: 408-988-7667
  • Fax: 408-988-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. MALCOM K BURKE
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-988-7667