Provider Demographics
NPI:1578031027
Name:TLC, HEALTH & EDUCATION SERVICES, INC.
Entity Type:Organization
Organization Name:TLC, HEALTH & EDUCATION SERVICES, INC.
Other - Org Name:TLC HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SAMPLE-ORMES
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,NP-BC
Authorized Official - Phone:623-221-4409
Mailing Address - Street 1:2940 W WANDER RD
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6903
Mailing Address - Country:US
Mailing Address - Phone:623-221-4409
Mailing Address - Fax:
Practice Address - Street 1:2940 W WANDER RD
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-6903
Practice Address - Country:US
Practice Address - Phone:623-221-4409
Practice Address - Fax:623-465-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ507246-03Medicaid
AZ695455OtherACCESS ARIZONA MEDICAID