Provider Demographics
NPI:1245332568
Name:TLC OF SOUTHERN & CENTRAL ILLINOIS INC.
Entity type:Organization
Organization Name:TLC OF SOUTHERN & CENTRAL ILLINOIS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMMYE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBB
Authorized Official - Suffix:
Authorized Official - Credentials:CCC/SLP
Authorized Official - Phone:618-985-2181
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0364
Mailing Address - Country:US
Mailing Address - Phone:618-985-2181
Mailing Address - Fax:618-985-6055
Practice Address - Street 1:1703 POTEETE
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-0364
Practice Address - Country:US
Practice Address - Phone:618-985-2181
Practice Address - Fax:618-985-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X, 225200000X, 235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361020501001Medicaid
IL491465822001Medicaid
IL306044412001Medicaid