MEDICARE: TLC GROUP 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1922886878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC GROUP LLC

Provider Business Mailing Address
First Line	:	6521 SOUDER ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19149-2815
Country	:	US
Telephone Number	:	215-285-7499
Fax Number	:

Provider Business Practice Location Address
First Line	:	6521 SOUDER ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19149-2815
Country	:	US
Telephone Number	:	215-285-7499
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMED AMER
Credential	:
Telephone Number	:	215-285-7499

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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Directions to “TLC GROUP LLC ” Practice Location

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