Healthcare Provider Details

I. General information

NPI: 1972249357
Provider Name (Legal Business Name): AMEHAN TLC HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 SAINT JOHN AVE S
BOYNTON BEACH FL
33472-1112
US

IV. Provider business mailing address

16244 S MILITARY TRL STE 740
DELRAY BEACH FL
33484-6532
US

V. Phone/Fax

Practice location:
  • Phone: 561-843-1722
  • Fax:
Mailing address:
  • Phone: 561-843-1722
  • 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: MS. AMANDA HANVIVATPONG
Title or Position: OWNER
Credential:
Phone: 561-843-1722