Provider Demographics
NPI:1710058441
Name:TLC OF THE BAY AREA INC
Entity Type:Organization
Organization Name:TLC OF THE BAY AREA INC
Other - Org Name:VALLEY HOUSE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-988-7667
Mailing Address - Street 1:991 CLYDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054
Mailing Address - Country:US
Mailing Address - Phone:408-988-7667
Mailing Address - Fax:408-988-2867
Practice Address - Street 1:991 CLYDE AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054
Practice Address - Country:US
Practice Address - Phone:408-988-7667
Practice Address - Fax:408-988-2867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40276073OtherSTATE TAX ID
CAZZR06069HMedicaid
CAZZR06069HMedicaid
CA056069Medicare ID - Type Unspecified
9625527Medicare UPIN