Provider Demographics
NPI:1528399482
Name:THERAPEUTIC LIVINGS CENTERS FOR THE BLIND, INC.
Entity Type:Organization
Organization Name:THERAPEUTIC LIVINGS CENTERS FOR THE BLIND, INC.
Other - Org Name:TLC - SHOUP HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FORD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-708-1740
Mailing Address - Street 1:7915 LINDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2122
Mailing Address - Country:US
Mailing Address - Phone:818-708-1740
Mailing Address - Fax:818-708-7899
Practice Address - Street 1:7355 SHOUP AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1737
Practice Address - Country:US
Practice Address - Phone:818-708-1740
Practice Address - Fax:818-708-7899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIN PROCESS315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities