1922075613 NPI number — TLC REHAB, LLC

Table of content: (NPI 1922075613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922075613 NPI number — TLC REHAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TLC REHAB, LLC
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:
1922075613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-382-7214
Provider Business Mailing Address Fax Number:
352-382-7781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8455 S SUNCOAST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOMOSASSA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34446-5066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-382-0939
Provider Business Practice Location Address Fax Number:
352-382-4297
Provider Enumeration Date:
03/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALDROP
Authorized Official First Name:
DREAMA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
352-382-7214

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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