Provider Demographics
NPI:1962500124
Name:DLCA LLC
Entity Type:Organization
Organization Name:DLCA LLC
Other - Org Name:DEDICATED LONGTERM CARE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENRICK
Authorized Official - Middle Name:SYLVESTER
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-292-6564
Mailing Address - Street 1:71 VISTA RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-8755
Mailing Address - Country:US
Mailing Address - Phone:513-292-6564
Mailing Address - Fax:
Practice Address - Street 1:71 VISTA RIDGE DR
Practice Address - Street 2:
Practice Address - City:SOUTH LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45065-8755
Practice Address - Country:US
Practice Address - Phone:513-292-6564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty