Provider Demographics
NPI:1710170873
Name:TLC HOME SERVICES
Entity Type:Organization
Organization Name:TLC HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-683-3713
Mailing Address - Street 1:507 E CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BERTRAND
Mailing Address - State:MO
Mailing Address - Zip Code:63823-9753
Mailing Address - Country:US
Mailing Address - Phone:573-683-3713
Mailing Address - Fax:573-683-3681
Practice Address - Street 1:507 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:BERTRAND
Practice Address - State:MO
Practice Address - Zip Code:63823-9753
Practice Address - Country:US
Practice Address - Phone:573-683-3713
Practice Address - Fax:573-683-3681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0005256OtherDEPT. OF SOCIAL SERVICES