Provider Demographics
NPI:1518475045
Name:TLC HOMES LLC
Entity Type:Organization
Organization Name:TLC HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FACUNLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-446-4431
Mailing Address - Street 1:3350 CLAYTON ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2840
Mailing Address - Country:US
Mailing Address - Phone:925-446-4431
Mailing Address - Fax:925-822-3778
Practice Address - Street 1:3515 FARM BUREAU COURT
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519
Practice Address - Country:US
Practice Address - Phone:925-671-9372
Practice Address - Fax:925-671-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVA0000683315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities