Healthcare Provider Details

I. General information

NPI: 1073857546
Provider Name (Legal Business Name): TLJ ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 DEVON AVE
PARK RIDGE IL
60068-4649
US

IV. Provider business mailing address

900 DEVON AVE
PARK RIDGE IL
60068-4649
US

V. Phone/Fax

Practice location:
  • Phone: 847-685-0593
  • Fax: 847-685-0671
Mailing address:
  • Phone: 847-685-0593
  • Fax: 847-685-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHF100031
License Number StateIL

VIII. Authorized Official

Name: MR. THOMAS A MERLIN
Title or Position: ONWNER
Credential:
Phone: 847-685-0593