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	106E00000X	Assistant Behavior Analyst		FL

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	:	1801331921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC SKILLED CARE INC.

Provider Business Mailing Address
First Line	:	15655 75TH WAY N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33418-1851
Country	:	US
Telephone Number	:	561-674-3777
Fax Number	:

Provider Business Practice Location Address
First Line	:	15655 75TH WAY N
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33418-1851
Country	:	US
Telephone Number	:	561-674-3777
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICIA MUNOZ-UPTON
Credential	:
Telephone Number	:	561-674-3777

Provider Enumeration Date	:	12/28/2016
Last Update Date	:	12/28/2016

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