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General NPI Number Information
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NPI Number | 1336018795
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Entity Type | Organization
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Legal Business Name | TLC ADULT CARE HOME, LLC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 8294 E SIDNEY RD
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City | CRYSTAL
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State | MI
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Zip | 48818-9716
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Country | US
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Telephone | 989-235-6184
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Fax |
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Provider Business Mailing Address
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Address Line | 8294 E. SIDNEY RD. BOX 148
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City | CRYSTAL, MI 48818
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State | MI
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Zip | 48818
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Country | US
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Telephone | 989-235-6184
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Fax |
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Authorized Official
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Title or Position | LICENSEE/OWNER/CARE PROVIDER
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Name | MRS. DIANE MARIE SMITH
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Credential | HOME CARE PROVIDER
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Telephone | 989-235-6184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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