Provider Demographics
NPI:1659759983
Name:TLC HEALTHCARE
Entity Type:Organization
Organization Name:TLC HEALTHCARE
Other - Org Name:HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTHCARE
Authorized Official - Prefix:MS
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:JANEE
Authorized Official - Last Name:CRATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-253-6503
Mailing Address - Street 1:5421 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3313
Mailing Address - Country:US
Mailing Address - Phone:636-523-6503
Mailing Address - Fax:
Practice Address - Street 1:5421 VERNON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3313
Practice Address - Country:US
Practice Address - Phone:636-523-6503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO271560003104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness