Provider Demographics
NPI:1073018164
Name:TLC HOMES LLC
Entity Type:Organization
Organization Name:TLC HOMES LLC
Other - Org Name:SUTHERLAND HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:GRACE T
Authorized Official - Last Name:FACUNLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-305-3956
Mailing Address - Street 1:3350 CLAYTON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2837
Mailing Address - Country:US
Mailing Address - Phone:925-446-4431
Mailing Address - Fax:925-822-3778
Practice Address - Street 1:5166 SUTHERLAND DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-3146
Practice Address - Country:US
Practice Address - Phone:925-827-2700
Practice Address - Fax:925-822-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities