=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962409813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TLC SKILLED HEALTH CARE PROVIDERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 09/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3250 WILSHIRE BLVD SUITE # 1008
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-380-9991
-----------------------------------------------------
Fax | 213-387-2894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3250 WILSHIRE BLVD SUITE # 1008
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90010-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-380-9991
-----------------------------------------------------
Fax | 213-387-2894
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ ADMINISTRATOR
-----------------------------------------------------
Name | MISS MARIA ASUNCION POLINTAN TATOY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-380-9991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 980000768
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------