=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437202637
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TLC HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1017 BROAD ST # A
-----------------------------------------------------
City | NEW BERN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28560-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-633-0042
-----------------------------------------------------
Fax | 252-633-0257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1017 BROAD ST # A
-----------------------------------------------------
City | NEW BERN
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28560-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-633-0042
-----------------------------------------------------
Fax | 252-633-0257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. VICTOR JAMAL DOVE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-633-0042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC2788
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------