MEDICARE: WAY OF LIFE TCM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1063785301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAY OF LIFE TCM LLC

Provider Business Mailing Address
First Line	:	410 N DILLARD ST
Second Line	:	SUITE 104
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2853
Country	:	US
Telephone Number	:	407-287-6075
Fax Number	:	407-347-2093

Provider Business Practice Location Address
First Line	:	410 N DILLARD ST
Second Line	:	SUITE 104
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2853
Country	:	US
Telephone Number	:	407-287-6075
Fax Number	:	407-347-2093

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. TREVOR SEATON THOMAS
Credential	:
Telephone Number	:	321-217-7632

Provider Enumeration Date	:	02/16/2012
Last Update Date	:	02/16/2012

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Directions to “WAY OF LIFE TCM LLC ” Practice Location

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