Healthcare Provider Details

I. General information

NPI: 1164638748
Provider Name (Legal Business Name): TLS LITCHFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6023 LITCHFIELD LN
KALAMAZOO MI
49009-9128
US

IV. Provider business mailing address

6023 LITCHFIELD LN P.O. BOX 19316
KALAMAZOO MI
49019
US

V. Phone/Fax

Practice location:
  • Phone: 269-375-0438
  • Fax:
Mailing address:
  • Phone: 269-375-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS390283892
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS390263898
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS800281915
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS390271092
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS390257369
License Number StateMI

VIII. Authorized Official

Name: MR. CLEOPAS ALLAN KALIATI
Title or Position: OWNER
Credential: MA
Phone: 269-760-8553