1710303151 NPI number — TLC OPERATIONS, INC.

Table of content: MS. SYLVIA WILLIS DOUGLAS LMT (NPI 1235341439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710303151 NPI number — TLC OPERATIONS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC OPERATIONS, 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:
6
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:
1710303151
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
747 CHAPPELL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27606-3215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-832-3909
Provider Business Mailing Address Fax Number:
919-863-2021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
747 CHAPPELL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27606-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-832-3909
Provider Business Practice Location Address Fax Number:
919-863-2021
Provider Enumeration Date:
03/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
919-832-3909

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  MHL 092-504 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: T2021 DAY SUPPT. ADU , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0045 B3 IND. . This is a "IPRS STATE RESPITE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3408753 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: S5150 INN. RESPITE , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0045HQ RESPITE G CH , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: B3H0045HBHQ RESPITE , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: YP010 RESPITE . This is a "NCSTATE IPRS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: H0045HB RESPITE ADUL , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: T2025 SPEC. CONSULT , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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