Provider Demographics
NPI:1437202637
Name:TLC HOME HEALTH CARE
Entity Type:Organization
Organization Name:TLC HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-633-0042
Mailing Address - Street 1:1017 BROAD ST # A
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-5509
Mailing Address - Country:US
Mailing Address - Phone:252-633-0042
Mailing Address - Fax:252-633-0257
Practice Address - Street 1:1017 BROAD ST # A
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-5509
Practice Address - Country:US
Practice Address - Phone:252-633-0042
Practice Address - Fax:252-633-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2788251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408060Medicaid
NC6601145Medicaid