Healthcare Provider Details

I. General information

NPI: 1306388103
Provider Name (Legal Business Name): A LOT OF EXTRA TLC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N ARGONNE RD STE 8A
SPOKANE VALLEY WA
99212-2700
US

IV. Provider business mailing address

708 N ARGONNE RD STE 8A
SPOKANE VALLEY WA
99212-2700
US

V. Phone/Fax

Practice location:
  • Phone: 509-922-1141
  • Fax: 509-922-1894
Mailing address:
  • Phone: 509-922-1141
  • Fax: 509-922-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberIHS.FS.60686247
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberIHS.FS.60686247
License Number StateWA

VIII. Authorized Official

Name: MRS. DENISE RENE JOHNSON
Title or Position: OWNER/ DIRECTOR
Credential:
Phone: 509-922-1141