Healthcare Provider Details

I. General information

NPI: 1194312819
Provider Name (Legal Business Name): TLM RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 5TH AVE STE 112
YOUNGSTOWN OH
44504-1765
US

IV. Provider business mailing address

3631 SANDBURG DR
YOUNGSTOWN OH
44511-1115
US

V. Phone/Fax

Practice location:
  • Phone: 234-254-8895
  • Fax: 234-719-1144
Mailing address:
  • Phone: 330-881-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TONI L. MITCHELL
Title or Position: OWNER/PROGRAM DIRECTOR
Credential:
Phone: 330-881-2102