Provider Demographics
NPI:1164638748
Name:TLS LITCHFIELD, LLC
Entity Type:Organization
Organization Name:TLS LITCHFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEOPAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:KALIATI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:269-760-8553
Mailing Address - Street 1:6023 LITCHFIELD LN
Mailing Address - Street 2:P.O. BOX 19316
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49019
Mailing Address - Country:US
Mailing Address - Phone:269-375-0438
Mailing Address - Fax:
Practice Address - Street 1:6023 LITCHFIELD LN
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9128
Practice Address - Country:US
Practice Address - Phone:269-375-0438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS390257369320600000X
MIAS390263898320600000X
MIAS390283892320600000X
MIAS800281915320600000X
MIAS390271092320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities