Provider Demographics
NPI:1558387530
Name:TLC ASSISTED LIVING SERVICES, INC
Entity Type:Organization
Organization Name:TLC ASSISTED LIVING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:606-327-2701
Mailing Address - Street 1:1701 CENTRAL AVE
Mailing Address - Street 2:SUITE 334
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7767
Mailing Address - Country:US
Mailing Address - Phone:606-327-2701
Mailing Address - Fax:606-327-5606
Practice Address - Street 1:1701 CENTRAL AVE
Practice Address - Street 2:SUITE 334
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7767
Practice Address - Country:US
Practice Address - Phone:606-327-2701
Practice Address - Fax:606-327-5606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2629409Medicaid