Healthcare Provider Details

I. General information

NPI: 1497154330
Provider Name (Legal Business Name): TLC PROFESSIONAL SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2014
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 RIVERSIDE DR SUITE 35
DANVILLE VA
24540-4267
US

IV. Provider business mailing address

2321 RIVERSIDE DR SUITE 35
DANVILLE VA
24540-4267
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-3500
  • Fax: 434-799-3525
Mailing address:
  • Phone: 434-799-3500
  • Fax: 434-799-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberS5189933
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberS5189933
License Number StateVA

VIII. Authorized Official

Name: MRS. LORI WILSON OWENS
Title or Position: MEMBER
Credential: RN, BSN
Phone: 434-799-3500