MEDICARE: TLC ADULT DAY 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	261QA0600X	Adult Day Care Clinic/Center		NY

General Provider Information

NPI Number	:	1790278992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC ADULT DAY CARE LLC.

Provider Business Mailing Address
First Line	:	3305 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6945
Country	:	US
Telephone Number	:	718-292-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3305 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6945
Country	:	US
Telephone Number	:	718-292-7700
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. JACOB GREEN
Credential	:
Telephone Number	:	718-292-7700

Provider Enumeration Date	:	06/12/2018
Last Update Date	:	12/27/2018

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