MEDICARE: TEXAS TLC HOME HEALTH CARE PROVIDERS INC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1255773677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS TLC HOME HEALTH CARE PROVIDERS INC

Provider Business Mailing Address
First Line	:	1911 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1629
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-1629
Country	:	US
Telephone Number	:	760-782-7150
Fax Number	:

Authorized Official
Title or Position	:	AMINISTRATOR
Name	:	RUBY INGRAM
Credential	:
Telephone Number	:	760-782-7150

Provider Enumeration Date	:	07/26/2013
Last Update Date	:	07/26/2013

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