Healthcare Provider Details

I. General information

NPI: 1275849747
Provider Name (Legal Business Name): TLC NURSING ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 WILLISTON RD
SOUTH BURLINGTON VT
05403-6422
US

IV. Provider business mailing address

PO BOX 2244
SOUTH BURLINGTON VT
05407-2244
US

V. Phone/Fax

Practice location:
  • Phone: 802-735-1123
  • Fax: 877-867-9432
Mailing address:
  • Phone: 802-735-1123
  • Fax: 877-867-9432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03723
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number03731
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateVT

VIII. Authorized Official

Name: MR. MOHAMED BASHA
Title or Position: CEO
Credential: RN
Phone: 802-735-1123