Provider Demographics
NPI: | 1245430875 |
---|---|
Name: | TLC ENTERPRISE, INC. |
Entity Type: | Organization |
Organization Name: | TLC ENTERPRISE, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ROSLYNN |
Authorized Official - Middle Name: | GAIL |
Authorized Official - Last Name: | PALMER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 951-579-4632 |
Mailing Address - Street 1: | 30141 ANTELOPE RD |
Mailing Address - Street 2: | STE. D647 |
Mailing Address - City: | MENIFEE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92584-8066 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 951-579-4632 |
Mailing Address - Fax: | 888-377-1590 |
Practice Address - Street 1: | 23529 LITTLE CREEK DR |
Practice Address - Street 2: | |
Practice Address - City: | CANYON LAKE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92587-7431 |
Practice Address - Country: | US |
Practice Address - Phone: | 951-579-4632 |
Practice Address - Fax: | 888-377-1590 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-07-22 |
Last Update Date: | 2007-07-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 343900000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) |