Provider Demographics
NPI:1851169718
Name:TLT CARE HOME LLC
Entity Type:Organization
Organization Name:TLT CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-365-1357
Mailing Address - Street 1:12033 CAMINO VALENCIA
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7622
Mailing Address - Country:US
Mailing Address - Phone:310-365-1357
Mailing Address - Fax:
Practice Address - Street 1:12033 CAMINO VALENCIA
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7622
Practice Address - Country:US
Practice Address - Phone:310-365-1357
Practice Address - Fax:562-239-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility