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General NPI Number Information
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NPI Number | 1659759983
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Entity Type | Organization
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Legal Business Name | TLC HEALTHCARE
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 5421 VERNON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63112-3313
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Country | US
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Telephone | 636-523-6503
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Fax |
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Provider Business Mailing Address
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Address Line | 5421 VERNON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63112-3313
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Country | US
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Telephone | 636-523-6503
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE
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Name | MS. LATISHA JANEE CRATE
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Credential |
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Telephone | 636-253-6503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 27156000
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License Number State | MO
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