1366731523 NPI number — TLC HOME CARE SERVICES OF CENTRAL FL INC

Table of content: (NPI 1366731523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366731523 NPI number — TLC HOME CARE SERVICES OF CENTRAL FL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC HOME CARE SERVICES OF CENTRAL FL 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:
Provider Other Organization Name Type Code:
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:
1366731523
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
238 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 155
Provider Business Mailing Address City Name:
CASSELBERRY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-972-4067
Provider Business Mailing Address Fax Number:
407-386-3056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 TIMBERLACHEN CIR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-6124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-878-1296
Provider Business Practice Location Address Fax Number:
407-386-3056
Provider Enumeration Date:
03/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SERRA
Authorized Official First Name:
JAZMIN
Authorized Official Middle Name:
FLOR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-618-9949

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299993783 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com