Healthcare Provider Details

I. General information

NPI: 1336892629
Provider Name (Legal Business Name): TLC PRIVATE HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST
BUZZARDS BAY MA
02532-3106
US

IV. Provider business mailing address

25 MAIN ST
BUZZARDS BAY MA
02532-3106
US

V. Phone/Fax

Practice location:
  • Phone: 508-383-3956
  • Fax:
Mailing address:
  • Phone: 508-383-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ANJOLI FISHER
Title or Position: MEDICAL BILLER
Credential:
Phone: 781-540-1269