Provider Demographics
NPI:1134309503
Name:TLCHEALTHCARE,LTD
Entity type:Organization
Organization Name:TLCHEALTHCARE,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAHNAZ
Authorized Official - Middle Name:NOORI
Authorized Official - Last Name:KHAVIDI
Authorized Official - Suffix:
Authorized Official - Credentials:APN,ND
Authorized Official - Phone:847-673-4444
Mailing Address - Street 1:4954 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2905
Mailing Address - Country:US
Mailing Address - Phone:847-673-4444
Mailing Address - Fax:847-673-4572
Practice Address - Street 1:4954 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2905
Practice Address - Country:US
Practice Address - Phone:847-673-4444
Practice Address - Fax:847-673-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209207Medicare PIN