Provider Demographics
NPI:1942322037
Name:TLC MEDICAL DAYCARE FOR ADULTS, INC
Entity Type:Organization
Organization Name:TLC MEDICAL DAYCARE FOR ADULTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FISKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, C
Authorized Official - Phone:603-224-8171
Mailing Address - Street 1:211 LOUDON RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-6099
Mailing Address - Country:US
Mailing Address - Phone:603-224-8171
Mailing Address - Fax:603-224-8150
Practice Address - Street 1:211 LOUDON RD
Practice Address - Street 2:SUITE H
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-6099
Practice Address - Country:US
Practice Address - Phone:603-224-8171
Practice Address - Fax:603-224-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02560311Z00000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011353Medicaid
NH30011500Medicaid