Provider Demographics
NPI:1760763023
Name:TLC HOME NURSING AND THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:TLC HOME NURSING AND THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEMPSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:580-564-0000
Mailing Address - Street 1:601 HWY 70 N
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OK
Mailing Address - Zip Code:73439-8155
Mailing Address - Country:US
Mailing Address - Phone:580-564-0000
Mailing Address - Fax:580-564-0004
Practice Address - Street 1:601 HWY 70 N
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-8155
Practice Address - Country:US
Practice Address - Phone:580-564-0000
Practice Address - Fax:580-564-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKHC7972251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health