MEDICARE: TLC HOME CARE 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	251G00000X	Community Based Hospice Care Agency	1015887	AK
2	253Z00000X	In Home Supportive Care Agency	1015887	AK
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1669862793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC HOME CARE LLC

Provider Business Mailing Address
First Line	:	500 E TUDOR RD STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7377
Country	:	US
Telephone Number	:	907-602-5811
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E TUDOR RD STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-7377
Country	:	US
Telephone Number	:	907-602-5811
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSALINA MAVAEGA
Credential	:
Telephone Number	:	907-602-5811

Provider Enumeration Date	:	01/27/2015
Last Update Date	:	03/12/2020

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