MEDICARE: TLC SKILLED CARE 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1649920372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC SKILLED CARE INC.

Provider Business Mailing Address
First Line	:	1224 US 1 STE H
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3539
Country	:	US
Telephone Number	:	561-203-8181
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 US HIGHWAY 1 STE H
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3539
Country	:	US
Telephone Number	:	561-203-8181
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	PAMELA JEAN JOHNSON
Credential	:
Telephone Number	:	561-203-8181

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	04/01/2022

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