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
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1477718864
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	:	777 LAFAYETTE RD
Second Line	:
City	:	HAMPTON
State	:	NH
Zip	:	03842-1228
Country	:	US
Telephone Number	:	603-929-3032
Fax Number	:	603-926-6236

Authorized Official
Title or Position	:	OFFICER
Name	:	MR. TIMOTHY COBURN
Credential	:
Telephone Number	:	860-930-0091

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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