Healthcare Provider Details

I. General information

NPI: 1902700719
Provider Name (Legal Business Name): TLC IN HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7674 MANDAN RD
GREENBELT MD
20770-2164
US

IV. Provider business mailing address

7674 MANDAN RD
GREENBELT MD
20770-2164
US

V. Phone/Fax

Practice location:
  • Phone: 301-996-5912
  • Fax:
Mailing address:
  • Phone: 301-996-5912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE MENTORE
Title or Position: CEO / EXECUTIVE DIRECTOR
Credential:
Phone: 301-996-5912