Provider Demographics
NPI:1902200249
Name:TLC COMPANIONS LLC
Entity Type:Organization
Organization Name:TLC COMPANIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KORNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-942-3705
Mailing Address - Street 1:1407 LEESON AVE
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-9098
Mailing Address - Country:US
Mailing Address - Phone:231-942-3705
Mailing Address - Fax:
Practice Address - Street 1:1407 LEESON AVE
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9098
Practice Address - Country:US
Practice Address - Phone:231-942-3705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care