Provider Demographics
NPI:1821775461
Name:TLC PRIVATE CARE LLC
Entity Type:Organization
Organization Name:TLC PRIVATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEASE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:CHAMBLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-909-4286
Mailing Address - Street 1:6300 E HAMPDEN AVE UNIT C365
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7678
Mailing Address - Country:US
Mailing Address - Phone:720-909-4286
Mailing Address - Fax:
Practice Address - Street 1:7200 E QUINCY AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2255
Practice Address - Country:US
Practice Address - Phone:720-909-4286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-04
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1821775461Medicaid
CO1821775461OtherIN HOME SUPPORT SERVICES