Provider Demographics
NPI:1215377759
Name:TLC FAMILY CARE HOME, INC.
Entity Type:Organization
Organization Name:TLC FAMILY CARE HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-343-0433
Mailing Address - Street 1:34017 S HAINES CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-4317
Mailing Address - Country:US
Mailing Address - Phone:352-343-0433
Mailing Address - Fax:866-608-4948
Practice Address - Street 1:34017 S HAINES CREEK RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-4317
Practice Address - Country:US
Practice Address - Phone:352-343-0433
Practice Address - Fax:866-608-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12030310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility