Provider Demographics
NPI:1568519320
Name:THE TINY TIM CENTER, INC.
Entity Type:Organization
Organization Name:THE TINY TIM CENTER, INC.
Other - Org Name:TLC LEARNING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-776-7417
Mailing Address - Street 1:611 KORTE WAY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6366
Mailing Address - Country:US
Mailing Address - Phone:303-776-7417
Mailing Address - Fax:303-776-7471
Practice Address - Street 1:611 KORTE WAY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6366
Practice Address - Country:US
Practice Address - Phone:303-776-7417
Practice Address - Fax:303-776-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13134086Medicaid
CO=========OtherTIN