Healthcare Provider Details

I. General information

NPI: 1619157021
Provider Name (Legal Business Name): TLC ON SUNSET CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NW 11TH AVE
OKEECHOBEE FL
34972-2837
US

IV. Provider business mailing address

105 NW 11TH AVE
OKEECHOBEE FL
34972-2837
US

V. Phone/Fax

Practice location:
  • Phone: 863-484-3800
  • Fax: 863-248-8172
Mailing address:
  • Phone: 863-484-3800
  • Fax: 863-248-8172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299992951
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA BONET
Title or Position: PRESIDENT
Credential:
Phone: 786-838-9531