MEDICARE: TLC IN-HOME SERVICES, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1851804074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC IN-HOME SERVICES, LLC

Provider Business Mailing Address
First Line	:	875 W SUMMIT AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4047
Country	:	US
Telephone Number	:	616-414-9440
Fax Number	:	944-364-2565

Provider Business Practice Location Address
First Line	:	875 W SUMMIT AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4047
Country	:	US
Telephone Number	:	616-414-9440
Fax Number	:	844-364-2565

Authorized Official
Title or Position	:	OWNER
Name	:	STACEY LYNN MILLER
Credential	:
Telephone Number	:	616-414-9440

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	08/27/2021

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