MEDICARE: TLC EARLY LEARNING AND PLAY CENTER

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1326460254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC EARLY LEARNING AND PLAY CENTER

Provider Business Mailing Address
First Line	:	1659 S HIGHWAY 65 82
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-1661
Country	:	US
Telephone Number	:	870-265-4191
Fax Number	:	870-265-5514

Provider Business Practice Location Address
First Line	:	1659 S HIGHWAY 65 82
Second Line	:
City	:	LAKE VILLAGE
State	:	AR
Zip	:	71653-1661
Country	:	US
Telephone Number	:	870-265-4191
Fax Number	:	870-265-5514

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. COREY JERMAINE SYKES
Credential	:
Telephone Number	:	870-265-4191

Provider Enumeration Date	:	01/12/2014
Last Update Date	:	01/12/2014

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