Provider Demographics
NPI:1417403403
Name:TLC
Entity Type:Organization
Organization Name:TLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:AKERS
Authorized Official - Suffix:
Authorized Official - Credentials:SF
Authorized Official - Phone:540-415-0009
Mailing Address - Street 1:100 NUGGET RIDGE RD
Mailing Address - Street 2:APT 710B
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3359
Mailing Address - Country:US
Mailing Address - Phone:540-415-0009
Mailing Address - Fax:540-750-4076
Practice Address - Street 1:100 NUGGET RIDGE RD
Practice Address - Street 2:APT 710B
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3359
Practice Address - Country:US
Practice Address - Phone:540-415-0009
Practice Address - Fax:540-750-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0175641452Medicaid