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General NPI Number Information
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NPI Number | 1497154330
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Entity Type | Organization
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Legal Business Name | TLC PROFESSIONAL SUPPORT SERVICES, LLC
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Dates
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Enumeration Date | 08/16/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 2321 RIVERSIDE DR SUITE 35
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City | DANVILLE
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State | VA
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Zip | 24540-4267
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Country | US
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Telephone | 434-799-3500
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Fax | 434-799-3525
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Provider Business Mailing Address
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Address Line | 2321 RIVERSIDE DR SUITE 35
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City | DANVILLE
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State | VA
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Zip | 24540-4267
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Country | US
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Telephone | 434-799-3500
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Fax | 434-799-3525
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. LORI WILSON OWENS
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Credential | RN, BSN
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Telephone | 434-799-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | S5189933
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | S5189933
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License Number State | VA
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