Provider Demographics
NPI:1851514624
Name:TLC ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:TLC ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:ERIBAL
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-441-9595
Mailing Address - Street 1:2401 OAK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3267
Mailing Address - Country:US
Mailing Address - Phone:907-278-0308
Mailing Address - Fax:907-278-0408
Practice Address - Street 1:2401 OAK DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3267
Practice Address - Country:US
Practice Address - Phone:907-278-0308
Practice Address - Fax:907-278-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK738560310400000X
AKRL5743385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK=========Medicaid