Healthcare Provider Details

I. General information

NPI: 1942322037
Provider Name (Legal Business Name): TLC MEDICAL DAYCARE FOR ADULTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 LOUDON RD SUITE H
CONCORD NH
03301-6099
US

IV. Provider business mailing address

211 LOUDON RD SUITE H
CONCORD NH
03301-6099
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-8171
  • Fax: 603-224-8150
Mailing address:
  • Phone: 603-224-8171
  • Fax: 603-224-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number02560
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number02560
License Number StateNH

VIII. Authorized Official

Name: MRS. JEAN C FISKE
Title or Position: PRESIDENT
Credential: RN, C
Phone: 603-224-8171