Healthcare Provider Details

I. General information

NPI: 1669810438
Provider Name (Legal Business Name): TLC HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15101 SW 87TH AVE
PALMETTO BAY FL
33176-8054
US

IV. Provider business mailing address

12990 NEVADA ST
CORAL GABLES FL
33156-6432
US

V. Phone/Fax

Practice location:
  • Phone: 305-232-1209
  • Fax:
Mailing address:
  • Phone: 305-342-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAL5898
License Number StateFL

VIII. Authorized Official

Name: BARBARA CLIFFORD
Title or Position: PRESIDENT
Credential:
Phone: 305-342-4307