Healthcare Provider Details

I. General information

NPI: 1558723189
Provider Name (Legal Business Name): TLT PHILLIPS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E MAIN ST
LEXINGTON KY
40502-1602
US

IV. Provider business mailing address

1107 VALLEY RUN DR
RICHMOND KY
40475-3439
US

V. Phone/Fax

Practice location:
  • Phone: 859-408-1145
  • Fax:
Mailing address:
  • Phone: 859-408-1145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number500239
License Number StateKY

VIII. Authorized Official

Name: MRS. LYNN T. PHILLIPS
Title or Position: OWNER/MGR
Credential:
Phone: 859-408-1145