Healthcare Provider Details

I. General information

NPI: 1790278992
Provider Name (Legal Business Name): TLC ADULT DAY CARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 3RD AVE
BRONX NY
10456-6945
US

IV. Provider business mailing address

3305 3RD AVE
BRONX NY
10456-6945
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-7700
  • Fax:
Mailing address:
  • Phone: 718-292-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. JACOB GREEN
Title or Position: MEMBER
Credential:
Phone: 718-292-7700