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General NPI Number Information
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NPI Number | 1073857546
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Entity Type | Organization
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Legal Business Name | TLJ ENTERPRISES
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 900 DEVON AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-4649
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Country | US
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Telephone | 847-685-0593
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Fax | 847-685-0671
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Provider Business Mailing Address
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Address Line | 900 DEVON AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-4649
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Country | US
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Telephone | 847-685-0593
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Fax | 847-685-0671
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Authorized Official
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Title or Position | ONWNER
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Name | MR. THOMAS A MERLIN
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Credential |
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Telephone | 847-685-0593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | HF100031
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License Number State | IL
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