Provider Demographics
NPI:1124201215
Name:HUMANA AT HOME (TLC), INC.
Entity Type:Organization
Organization Name:HUMANA AT HOME (TLC), INC.
Other - Org Name:SENIORBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CLINICAL QUALITY
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-258-7709
Mailing Address - Street 1:845 3RD AVE
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-994-6100
Mailing Address - Fax:972-758-0552
Practice Address - Street 1:2001 W JOHN CARPENTER FWY STE 142
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3255
Practice Address - Country:US
Practice Address - Phone:972-422-1375
Practice Address - Fax:972-758-0552
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROHC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-11
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016484251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX006712OtherTX DADS