Healthcare Provider Details

I. General information

NPI: 1689136194
Provider Name (Legal Business Name): TLC PROFESSIONAL HOME CARE SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 S BLUFORD AVE
OCOEE FL
34761-2752
US

IV. Provider business mailing address

687 S BLUFORD AVE
OCOEE FL
34761-2752
US

V. Phone/Fax

Practice location:
  • Phone: 407-924-3979
  • Fax: 407-876-4426
Mailing address:
  • Phone: 407-924-3979
  • Fax: 407-876-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TERCIA L COLLARD
Title or Position: ADMINISTRATOR/OWNER
Credential: MSN,RN
Phone: 407-924-3979