Provider Demographics
NPI:1497952519
Name:TLC ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:TLC ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLAUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-775-6316
Mailing Address - Street 1:713 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:SD
Mailing Address - Zip Code:57523-0713
Mailing Address - Country:US
Mailing Address - Phone:605-775-6316
Mailing Address - Fax:605-775-2795
Practice Address - Street 1:713 COUNTY RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:SD
Practice Address - Zip Code:57523-0713
Practice Address - Country:US
Practice Address - Phone:605-775-6316
Practice Address - Fax:605-775-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD46982310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility