Provider Demographics
NPI:1558627273
Name:TLC HOSPICE
Entity Type:Organization
Organization Name:TLC HOSPICE
Other - Org Name:TENDER CARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:SQUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-602-1802
Mailing Address - Street 1:139 W 2070 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7513
Mailing Address - Country:US
Mailing Address - Phone:801-602-1802
Mailing Address - Fax:
Practice Address - Street 1:503 W 2600 S STE 200
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-7717
Practice Address - Country:US
Practice Address - Phone:801-294-0560
Practice Address - Fax:801-992-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based