MEDICARE: TCC CARE SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1396114914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TCC CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	9875 VILLAGE CENTER DR
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6691
Country	:	US
Telephone Number	:	916-512-3299
Fax Number	:	916-512-3353

Provider Business Practice Location Address
First Line	:	6806 FALLSBROOK CT
Second Line	:	SUITE A-1
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-6512
Country	:	US
Telephone Number	:	916-512-3299
Fax Number	:	916-512-3353

Authorized Official
Title or Position	:	OWNER/ GENERAL MANAGER
Name	:	DAVID MOELLER
Credential	:
Telephone Number	:	916-512-3299

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	09/24/2015

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