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NPI Code Detail

MEDICARE: TC HEALTHCARE I, LLC

MEDICARE: TC HEALTHCARE I, 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1144482407
Entity Type Code : Organization
Provider Name (Legal Business Name) : TC HEALTHCARE I, LLC
Provider Business Mailing Address
First Line : 86 JUNIPER LN
Second Line :
City : GLASTONBURY
State : CT
Zip : 06033-2515
Country : US
Telephone Number : 860-930-0091
Fax Number :
Provider Business Practice Location Address
First Line : 642 METACOM AVE
Second Line :
City : WARREN
State : RI
Zip : 02885-2350
Country : US
Telephone Number : 401-245-2860
Fax Number : 401-245-0959
Authorized Official
Title or Position : OFFICER
Name : MR. TIMOTHY COBURN
Credential :
Telephone Number : 860-930-0091
Provider Enumeration Date : 06/27/2008
Last Update Date : 06/27/2008

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