Healthcare Provider Details

I. General information

NPI: 1144482407
Provider Name (Legal Business Name): TC HEALTHCARE I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 METACOM AVE
WARREN RI
02885-2350
US

IV. Provider business mailing address

86 JUNIPER LN
GLASTONBURY CT
06033-2515
US

V. Phone/Fax

Practice location:
  • Phone: 401-245-2860
  • Fax: 401-245-0959
Mailing address:
  • Phone: 860-930-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY COBURN
Title or Position: OFFICER
Credential:
Phone: 860-930-0091