MEDICARE: TLC PERSONAL CARE AGENCY 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	251E00000X	Home Health Agency		WI
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427597764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC PERSONAL CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	8105 W LISBON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-3826
Country	:	US
Telephone Number	:	414-212-8885
Fax Number	:

Provider Business Practice Location Address
First Line	:	8105 W LISBON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-3826
Country	:	US
Telephone Number	:	414-212-8885
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	REHAM KHALIL
Credential	:
Telephone Number	:	414-265-9299

Provider Enumeration Date	:	02/20/2017
Last Update Date	:	10/07/2025

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