Provider Demographics
NPI:1417223017
Name:TLC/TRANSITIONAL LIVING COMMUNITIES
Entity Type:Organization
Organization Name:TLC/TRANSITIONAL LIVING COMMUNITIES
Other - Org Name:TRANSITIONAL LIVING COMMUNITIES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:SCHWARY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CADAC
Authorized Official - Phone:602-763-2138
Mailing Address - Street 1:32 S. MACDONALD STREET
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-1310
Mailing Address - Country:US
Mailing Address - Phone:480-833-0143
Mailing Address - Fax:480-833-4266
Practice Address - Street 1:32 S. MACDONALD STREET
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1310
Practice Address - Country:US
Practice Address - Phone:480-833-0143
Practice Address - Fax:480-833-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3987251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health