Provider Demographics
NPI:1053859181
Name:TLC W
Entity Type:Organization
Organization Name:TLC W
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BEESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-292-2990
Mailing Address - Street 1:4480 HWY 16 S
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-9030
Mailing Address - Country:US
Mailing Address - Phone:828-469-6098
Mailing Address - Fax:
Practice Address - Street 1:4480 S NC 16 HWY
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-9030
Practice Address - Country:US
Practice Address - Phone:704-951-8408
Practice Address - Fax:704-951-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320800000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053859181Medicaid