1962409813 NPI number — TLC SKILLED HEALTH CARE PROVIDERS, INC.

Table of content: (NPI 1962409813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962409813 NPI number — TLC SKILLED HEALTH CARE PROVIDERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC SKILLED HEALTH CARE PROVIDERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIME NURSING SERVICES INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962409813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3250 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE # 1008
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90010-1577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-380-9991
Provider Business Mailing Address Fax Number:
213-387-2894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3250 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE # 1008
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90010-1577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-380-9991
Provider Business Practice Location Address Fax Number:
213-387-2894
Provider Enumeration Date:
07/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TATOY
Authorized Official First Name:
MARIA ASUNCION
Authorized Official Middle Name:
POLINTAN
Authorized Official Title or Position:
CEO/ ADMINISTRATOR
Authorized Official Telephone Number:
213-380-9991

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  980000768 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)