Provider Demographics
NPI:1629549464
Name:TLC ROOM AND BOARD
Entity Type:Organization
Organization Name:TLC ROOM AND BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE/OWNER
Authorized Official - Phone:661-317-3401
Mailing Address - Street 1:38059 RICHEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-3516
Mailing Address - Country:US
Mailing Address - Phone:661-317-3401
Mailing Address - Fax:
Practice Address - Street 1:38733 9TH ST E STE O
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2910
Practice Address - Country:US
Practice Address - Phone:661-317-3401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty