Provider Demographics
NPI:1700048063
Name:TC HEALTHCARE I, LLC
Entity Type:Organization
Organization Name:TC HEALTHCARE I, LLC
Other - Org Name:PAWTUCKET HEALTH CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-930-0091
Mailing Address - Street 1:86 JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2515
Mailing Address - Country:US
Mailing Address - Phone:860-930-0091
Mailing Address - Fax:
Practice Address - Street 1:70 GILL AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-4315
Practice Address - Country:US
Practice Address - Phone:401-722-7900
Practice Address - Fax:401-723-9670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility